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Case Reports
. 2005;32(4):595-7.

Starfish-assisted off-pump obliteration of massive coronary arteriovenous fistulae

Shen Sun  1 , Jiun-Yi Li, Po-Yuan Hu, Shye-Jao Wu
Affiliations
Case Reports

Starfish-assisted off-pump obliteration of massive coronary arteriovenous fistulae

Shen Sun et al. Tex Heart Inst J. 2005.

Abstract

Coronary arteriovenous fistula is a rare congenital heart disease. A 71-year-old woman suffered from heart failure due to massive coronary arteriovenous fistulae from the right coronary artery and left circumflex artery to the coronary sinus. Using the off-pump technique, we successfully performed Starfish-assisted obliteration of the fistulae. Intraoperative transesophageal echocardiography was used to confirm the complete elimination of the abnormal shunt flow.

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Figures

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Fig. 1 The coronary angiograms and the operative findings of the coronary arteriovenous fistulae. Panel A shows the dilated right coronary artery with aneurysmal formation (arrows), draining into the coronary sinus (arrowheads). Panel B reveals the smaller fistula from the left circumflex artery (arrow). Panel C shows the dilated and tortuous right coronary artery (arrowheads).
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Fig. 2 The use of the Trendelenburg position and the application of the Starfish™ on the apex, in order to lift the heart, enable the management of a deeply seated coronary arteriovenous fistula without cardiopulmonary bypass. The arrows indicate the location of the right coronary artery aneurysm, close to the drainage site into the coronary sinus (CS). The arrowheads point to the location of the fistula from the left circumflex artery.
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