Coronary Artery Fistula

Jan 11 2023 | Medicover Hospitals | Hyderabad- Hi-tech city

A 53-year-old female known case of hypertension presented with chest pain, palpitations, and progressive dyspnea on exertion for one year, ECG suggestive of Atrial Fibrillation, 2D Echo Findings (Fig1): suspicious RSOV shunt into RA, dilated RA, mild AR, normal systolic function. Coronary angiogram was suggestive of coronary Cameral Fistula from aneurysmal RCA to RA.

Operative finding: Coronary cameral fistula of 20mm size identified draining into RA at SVC junction (Fig3). Saphenous vein graft used for distal anastomosis to mid-RCA distal to aneurysmal segment. Following the aortic cross-clamp, an aortotomy has been performed. Left-side cardioplegia is given through left coronary ostia and right-side through vein graft for adequate myocardial protection. Aneurysmal dilated proximal RCA opened, and the ostium of mid-RCA was identified, closed with pledgeted suture excluded from the aneurysmal part; RCA is closed with a dacron patch and closed in double layer. The fistula opening in RA is closed with the pericardial patch (Fig 4). RA closed in layers. Weaned from cardiopulmonary bypass and decannulated.