Abstract
An asymptomatic 65-year-old woman was identified with an oversized round-shaped hypoechoic lesion (62 mm in diameter) between right and left atria by echocardiogram. A contrast-enhanced 320-slice multidetector computed tomography demonstrated a giant aneurysmatic fistula branched from the left main coronary trunk towards right atrium. The patient underwent an elective surgical repair. The aneurysm was resected, followed by coronary artery bypass graft surgery using bilateral internal thoracic arteries. The surgery was successful, and the patient enjoys normal life without any symptoms for 15 months.
Highlights
Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries [1]
A contrast-enhanced 320-slice multidetector computed tomography demonstrated a giant aneurysmatic fistula branched from the left main coronary trunk towards right atrium
Multidimensional computed tomography (MDCT) revealed lesion as a giant aneurysm of 58 mm in diameter with mural thrombus formed in the dilated winding vessel arising from left main coronary trunk (LMT) (Figure 2)
Summary
Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries [1]. Multidimensional computed tomography (MDCT) revealed lesion as a giant aneurysm of 58 mm in diameter with mural thrombus formed in the dilated winding vessel arising from left main coronary trunk (LMT) (Figure 2). LAD, left anterior descending artery; LCX, left circumflex coronary artery; LMT, left main coronary trunk; MDCT, multidimensional computed tomography; RA, right atrium. Bypass surgeries of the left internal thoracic artery to LAD and the right internal thoracic artery to LCX were performed (Figure 3C). Lower left quadrant image C: enlarged LMT branching LAD (red tape) and LCX (blue tape). Contrast CT one year post surgery showed that coronary artery aneurysm had disappeared and bypass vessels were intact (Figure 4). LAD, left anterior descending artery; LCX, left circumflex coronary artery; LITA, left internal thoracic artery; MDCT, multidimensional computed tomography; RITA, right internal thoracic artery
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