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. 2012 Nov;42(11):792-5.
doi: 10.4070/kcj.2012.42.11.792. Epub 2012 Nov 28.

Congenital giant right coronary artery aneurysm with fistula to the coronary sinus and persistent left superior vena cava in an old woman

Soo-Yong Lee  1 , Yong Hyun Park, Hye-Ju Yeo, Chang-Bae Sohn, Dong-Cheul Han, Jeong Su Kim, Jun Kim, June-Hong Kim, Kook-Jin Chun
Affiliations

Congenital giant right coronary artery aneurysm with fistula to the coronary sinus and persistent left superior vena cava in an old woman

Soo-Yong Lee et al. Korean Circ J. 2012 Nov.

Abstract

The combination of coronary arteriovenous fistula to the coronary sinus (CS), dilatation of the entire length of coronary artery, coronary aneurysm and persistent left superior vena cava (PLSVC) is very rare. We present the case of a 63-year-old female admitted for dyspnea on exertion, orthopnea, and facial edema. Echocardiography detected a giant coronary artery with shunt flow, dilated CS and PLSVC and a coronary angiography reaffirmed these findings. The calculated ratio of pulmonary blood flow to systemic blood flow by cardiac catheterization was 1.53. After multidisciplinary review considering old age, hypoactivity due to underlying Parkinsonism and relatively small amount of shunt flow, medical therapy was chosen. The patient remained asymptomatic for 10 months after discharge without intervention.

Keywords: Arteriovenous fistula; Coronary aneurysm; Coronary sinus.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiography. A: posteriorly angulated apical four-chamber view showed tortuous aneurysmal dilatation of right coronary artery (asterisk) terminating into the coronary sinus (arrow). B: color flow imaging showed shunt flow from the right coronary artery (asterisk) into the coronary sinus (arrow). C: continuous-wave Doppler demonstrated shunt flow throughout whole cardiac cycle with high velocity (4 m/sec). Ao: aorta, CS: coronary sinus, LV: left ventricle, RV: right ventricle.
Fig. 2
Fig. 2
Volume-rendenered 3-dimensional images of multidetector computed tomography angiogram. A: giant right coronary artery (asterisk); PLSVC (arrow) and left innominate vein ran below the aortic arch (arrow head). B: giant right coronary artery from the initial segement (asterisk); A serpentine coronary artery formed a round mass at the distal end with an opening to the coronary sinus (arrow). An: aneurysm, Ao: aorta, PA: pulmonary artery, PLSVC: persistent left superior vena cava.
Fig. 3
Fig. 3
Angiography. A: venography with catheterization via coronary sinus to PLSVC (asterisk). B: coronary angiography with pigtail catheter showed the large and tortuous RCA, CS and PLSVC filled with contrast material. Arrow indicates the confluence of PLSVC and RCA to CS. C: drawing elucidating angiographic findings. INN: innominate vein, PLSVC: persistent left superior vena cava, An: aneurysm, Ao: aorta, CS: coronary sinus, IVC: inferior vena cava, PA: pulmonary artery, RA: right atrium, RCA: right coronary artery, RV: right ventricle, SVC: superior vena cava.
See this image and copyright information in PMC

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