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Intraoperative transesophageal echocardiography of coronary artery fistulas
J G Stevenson1, G K Sorensen, S J Stamm
1Division of Cardiology, Children's Hospital and Medical Center, Seattle, Washington.
Insights
Transesophageal echocardiography precisely locates coronary artery fistulas, avoiding cardiopulmonary bypass. This technique monitors ventricular function and confirms shunt closure during surgery.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Echocardiography
Background:
- Coronary artery fistula (CAF) is a rare congenital or acquired abnormality with significant surgical implications.
- Surgical intervention aims to abolish fistulous shunt volume, prevent progressive coronary dilatation, and mitigate coronary steal.
- Traditional methods rely on intraoperative direct inspection during cardiopulmonary bypass to identify fistula drainage sites.
Observation:
- This study reports on three patients with coronary artery fistulas.
- Intraoperative transesophageal echocardiography (TEE) was employed for precise localization of the fistulous drainage site.
- TEE also selectively demonstrated the vessels supplying the fistulas.
Findings:
- TEE enabled precise localization of the fistulous drainage site without the need for cardiopulmonary bypass.
- The technique successfully visualized the vessels feeding the fistulas.
- TEE documented the abolition of fistulous flow after surgical intervention.
- Continuous monitoring of ventricular function was achieved, allowing detection of potential ischemic effects from ligation.
Implications:
- Intraoperative TEE offers a valuable, non-bypass alternative for diagnosing and managing coronary artery fistulas.
- This imaging modality enhances surgical precision and patient safety by monitoring cardiac function.
- TEE facilitates a comprehensive assessment of fistula anatomy and surgical success.
Abstract:
Coronary artery fistula is a rare abnormality but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 patients in whom intraoperative transesophageal echocardiography was used for precise localization of the fistulous drainage site, selective demonstration of vessels feeding the fistulas, and documentation of abolition of fistulous flow, all without need for cardiopulmonary bypass. In addition, the technique provides for continuous monitoring of ventricular function, providing the opportunity to detect inadvertent ischemic effects of ligation. This approach appears to have considerable utility.