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The Annals of Thoracic Surgery, Vol 57, 1217-1221, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Intraoperative transesophageal echocardiography of coronary artery fistulas

JG Stevenson, GK Sorensen, SJ Stamm, JP McCloskey, DG Hall and EA Rittenhouse
Division of Cardiology, Children's Hospital and Medical Center, Seattle, Washington.

Coronary artery fistula is a rare abnormality 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 fistulous 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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