Usefulness of intraoperative transesophageal echocardiography for evaluation of circumflex coronary artery fistula with ruptured aneurysm draining into coronary sinus
Tóm tắt
A coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery to a diameter >1.5 times that of the adjoining normal coronary artery. Giant CAAs with a diameter ≥50 mm are quite rare. Coronary artery fistulas are also uncommon, and affected patients require prompt diagnosis and treatment. Coronary angiography is the most common method of diagnosing coronary artery fistulas; however, transesophageal echocardiography (TEE) can also be a key intraoperative tool. In the present report, we describe the case of an 83-year-old man urgently admitted to our hospital with pericardial tamponade. Enhanced computed tomography and coronary angiography revealed a bulging left main and circumflex artery that was connected to a 50-mm diameter CAA. Emergency intraoperative TEE clearly showed a CAA with a surrounding hematoma, bulging circumflex artery, and a fistulous connection to the coronary sinus; the fistulous vessel contained a thrombus. Surgical repair was successful. This case demonstrates that CAA can rupture because of spontaneous closure of a thrombus-containing fistula and that intraoperative TEE could help to clearly identify the location of the CAA and fistulous connection.
Tài liệu tham khảo
Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis. 1997;40:77–84.
Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J. 2014;41:603–8.
Alcock R, Naoum C, Ng AC. Giant right coronary aneurysm: a case of mistaken identity. Eur Heart J. 2011;32:2712.
Morita H, Ozawa H, Yamazaki S, Yamauchi Y, Tsuji M, Katsumata T, Ishizaka N. A case of giant coronary artery aneurysm with fistulous connection to the pulmonary artery: a case report and review of the literature. Intern Med. 2012;51:1361–6.
Abusaid GH, Hughes D, Khalife WI, Parto P, Gilani SA, Fujise K. Congenital coronary artery fistula presenting later in life. J Cardiol Cases. 2011;4:e43–6.
Keyser A, Hilker MK, Husser O, Diez C, Schmid C. Giant coronary aneurysms exceeding 5 cm in size. Interact CardioVasc Thorac Surg. 2012;15:33–6.
Kumar K, Lepor NE, Naqvi TZ. Unusual presentation of an acute inferior myocardial infarction. Rev Cardiovasc Med. 2002;3:152–6.
Dogan A, Ozaydin M, Altinbas A, Gedikkli O. A giant aneurysm of the circumflex coronary artery with fistulous connection to the coronary sinus: a case report. Int J Cardiovasc Imag. 2006;19:5–8.
Chamberlain MH, Henry R, Brann S, Angelini GD. Surgical management of a gigantic circumflex coronary artery aneurysm with fistulous connection to the coronary sinus. Eur J Cardiothorac Surg. 2001;20:1255–7.
Kalangos A, Karaca S, Cikirikcioglu M, Vala D, Didier D. Aneurysmal circumflex coronary artery with fistulous connection to the coronary sinus. J Thorac Cardiovasc Surg. 2005;130:580–1.
Watanabe T, Saotome M, Kumazawa A, Urushida T, Katoh H, Satoh H, Terada H, Yamashita K, Shiya N, Hayashi H. Giant and aneurysmal left circumflex coronary fistula to coronary sinus—cardiovascular computed tomography imaging before and after surgical operation. J Cardiol Cases. 2012;5:e96–9.
Gupta V, Truong QA, Okada DR, Kiernan TJ, Yan BP, Cubeddu RJ, Roberts DJ, Abbara S, MacGillivray TE, Palacios IF. Images in cardiovascular medicine. Giant left circumflex coronary artery aneurysm with arteriovenous fistula to the coronary sinus. Circulation. 2008;25:2304–7.
Nakamura K, Shiratori K, Hashimoto K. Giant saccular aneurysm of coronary arteriovenous fistula to the main pulmonary artery: intraoperative assessment by using fluorescent imaging. Ann Thorac Cardiovasc Surg. 2010;16:354–7.
Nakamura M, Matsuoka H, Kawakami H, Komatsu J, Itou T, Higashino H, Kido T, Mochizuki T. Giant congenital coronary artery fistula to left brachial vein clearly detected by multidetector computed tomography. Circ J. 2006;70:796–9.
Mangukia CV. Coronary artery fistula. Ann Thorac Surg. 2012;93:2084–92.
Karthik S, Mahmood F, Panzica PJ, Khabbaz KR, Lerner AB. Intraoperative transesophageal echocardiographic visualization of a left anterior descending coronary artery aneurysm. Anesth Analg. 2007;104:263–4.
Inoue H, Ueno M, Yamamoto H, Matsumoto K, Tao K, Sakata R. Surgical treatment of coronary artery aneurysm with coronary artery fistula. Ann Thorac Cardiovasc Surg. 2009;15:198–202.
Mita N, Kaida S, Kagaya S, Miyoshi S, Kawauchi C, Kanemaru Y, Haque A. Giant coronary artery aneurysm with coronary arteriovenous fistula draining into the coronary sinus. J Anesth. 2011;25:749–52.
Nakahira A, Sasaki Y, Hirai H, Fukui T, Motoki M, Takahashi Y, Oe H, Kataoka T, Suehiro S. Rupture of aneurysmal circumflex coronary artery into the left atrium after ligation of its arteriovenous fistula. Circ J. 2007;71:1996–8.