title: Usefulness of intraoperative transesophageal echocardiography for evaluation of circumflex coronary artery fistula with ruptured aneurysm draining into coronary sinus.
abstract: A coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery to a diameter >1.5 times that of the adjoining normal coronary artery. Giant CAAs with a diameter ≥ 50 mm are quite rare. Coronary artery fistulas are also uncommon, and affected patients require prompt diagnosis and treatment. Coronary angiography is the most common method of diagnosing coronary artery fistulas; however, transesophageal echocardiography (TEE) can also be a key intraoperative tool. In the present report, we describe the case of an 83-year-old man urgently admitted to our hospital with pericardial tamponade. Enhanced computed tomography and coronary angiography revealed a bulging left main and circumflex artery that was connected to a 50-mm diameter CAA. Emergency intraoperative TEE clearly showed a CAA with a surrounding hematoma, bulging circumflex artery, and a fistulous connection to the coronary sinus; the fistulous vessel contained a thrombus. Surgical repair was successful. This case demonstrates that CAA can rupture because of spontaneous closure of a thrombus-containing fistula and that intraoperative TEE could help to clearly identify the location of the CAA and fistulous connection.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. ane026@poh.osaka-med.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sawai
authors.affiliation: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Nakahira
authors.affiliation: Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging*; D002305:Cardiac Tamponade / Q000209:etiology; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods; D016157:Vascular Fistula / Q000000981:diagnostic imaging
keywords: Circumflex coronary artery aneurysm; Fistula from coronary artery aneurysm to coronary sinus; Giant coronary artery aneurysm; Ruptured coronary artery aneurysm