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Ann Thorac Surg 1994;57:1217-1221
© 1994 The Society of Thoracic Surgeons

Articles

Intraoperative transesophageal echocardiography of coronary artery fistulas

J.Geoffrey Stevenson, MD*, Gregory K. Sorensen, MD, Stanley J. Stamm, MD, John P. McCloskey, MD, Dale G. Hall, MD, Edward A. Rittenhouse, MD

Divisions of Cardiology, Anesthesiology, and Cardiothoracir Surgery, Children's Hospital and Medical Center, and University of Washington, Seattle, Washington, USA

Accepted for publication August 24, 1993.

* Address reprint requests to Dr Stevenson, Cardiology, Children's Hospital and Medical Center, CH-11, PO Box C-5371, Seattle, WA 98105.

Coronary artery fistula is a rare abnorm lity but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 patients in whom intraoperative transesophageal echocardiography was used for precise localization of the fistulous drainage site, selective demonstration of vessels feeding the fistulas, and documentation of abolition of fistuloua flow, all without need for cardiopulmonary bypass. In addition, the technique provides for continuous monitoring of ventricular function, providing the opportunity to detect inadvertent ischemic effects of ligation. This approach appears to have considerable utility.




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