[A case report of coronary artery fistula in which perioperative transthoracic and transesophageal echocardiography was useful for surgical decision]

Abstract

Coronary artery fistula is rare in congenital heart diseases but is the major disease among "coronary" congenital diseases. In a coronary artery fistula, the coronary artery tip connects directly or via an unusual blood vessel to unusual parts, such as the inside of the heart chamber, pulmonary artery or superior vena cava. Left ventricular volume overload and coronary steal phenomenon are serious symptoms. The gold standard of diagnosis has been coronary angiography, but echocardiography using Doppler methods is now useful for its diagnosis. This is a case report of coronary artery fistula for which transthoracic echocardiography (TTE) during anesthetic induction and intraoperative transesophageal echocardiography (TEE) by anesthesiologists provided accurate diagnosis of the shunt position. A 62-year-old female was scheduled to undergo surgery for a coronary artery fistula and aneurysm. Two separate shunts from the coronary artery into the pulmonary artery had been suspected by preoperative TTE. Shunt orientation was reexamined by perioperative TTE and TEE. We confirmed that only one shunt was located at the supra pulmonary valve area, and we consulted the diagnosis to surgeons. As a result, one shunt was found in the surgical view at the same position. Perioperative TTE and TEE are useful for surgical decision.