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A simple, ingenious approach for intra-operative detection of coronary cameral fistula

Anshuman Darbari1, Ishan Jhalani1, Ajay Kumar2

  • 1CTVS Department, AIIMS, Rishikesh, India.

Asian Cardiovascular & Thoracic Annals
|June 6, 2024
PubMed

Insights

A 56-year-old woman with mitral stenosis and a left atrial clot underwent surgery. A novel methylene blue dye technique successfully closed a coronary fistula during the procedure, ensuring a smooth recovery.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Rheumatic mitral stenosis is a significant valvular heart disease.
  • Left atrial clots pose a risk of systemic embolism.
  • Coronary cameral fistulas are rare congenital or acquired abnormalities.

Observation:

  • A 56-year-old female patient presented with rheumatic mitral stenosis and a left atrial clot.
  • Coronary angiography revealed a fistula between the posterior left ventricular branch and the left ventricle.
  • The presence of a coronary fistula alongside mitral valve disease and a clot is uncommon.

Findings:

  • Surgical mitral valve replacement and clot removal were performed.
  • A methylene blue dye injection technique was utilized intraoperatively.
  • This technique facilitated the safe detection and closure of the coronary fistula from within the left ventricle.

Implications:

  • Safe closure of coronary fistulas is crucial to prevent complications like infective endocarditis, particularly with prosthetic valves.
  • Methylene blue dye injection offers a simple and effective method for intraoperative fistula management.
  • This approach ensures a favorable outcome in complex cardiac cases involving combined pathologies.

Keywords:
Coronary artery fistulacoronary cameral fistulamethylene bluerheumatic mitral stenosis

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