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J Thorac Cardiovasc Surg 2007;134:1057-1058
© 2007 The American Association for Thoracic Surgery

Brief Communication

Giant congenital left main coronary artery fistula to the superior vena cava in an adult patient with coronary artery disease

Ilias A. Kouerinis, MD, PhDa,*, Martha Deligianni, MDb, Vassilios Maniatis, MD, PhDb, Ilias Elefteriadis, MDb, Antonios Kourtesis, MDa, Nikolaos Michalopoulos, MDb

a Department of Cardiac Surgery, Aghia Sophia Children’s Hospital, Athens, Greece
b Iaso General Hospital, Athens, Greece.

Received for publication June 12, 2007; accepted for publication July 5, 2007.

* Address for reprints: Ilias Kouerinis, MD, PhD, 46 Doukissis Plakentias, Melissia, Athens, Greece. (Email: ikouerinis@hotmail.com).

The first 20% of the full text of this article appears below.


Figure 1
Dr Kouerinis


It is well established that coronary artery fistulae (CAFs) can cause dyspnea, fatigue, angina (7%), and infarction (3%) as a result of the coronary steal phenomenon.1Go Nevertheless, there are few reports in which a CAF was associated with coronary artery disease (CAD), and even fewer studies have examined the consequences of this association on coronary hemodynamics and myocardial blood flow.2,3Go

We present the surgical treatment of a giant left main coronary artery (LMCA) fistula draining into the superior vena cava and coexistent CAD, and we investigate the contribution of the coronary steal syndrome to this patient’s symptoms.

Clinical Summary

A 62-year-old man was referred to our department with the diagnosis of an LMCA fistula and double-vessel disease (left anterior descending coronary artery, 85%; circumflex artery, 80%; Figures 1, E1, and E2). Go Go Oxymetry had shown an increased oxygen saturation of 84% at the lower segment of the superior vena cava with high right ventricular filling pressures, and the Qp/Qs ratio was calculated at 1.4/1.


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  		Figure 1. Coronary angiogram analysis demonstrating the fistula. Note that the catheter has just inserted into the LMCA ostium. CAF, Coronary artery fistula; LMCA, left main coronary artery.

 

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  		Figure E1. Axial computed . . . [Full Text of this Article]

 





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