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Ann Thorac Surg 2007;83:1532-1534
© 2007 The Society of Thoracic Surgeons


Case Reports

Hybrid Therapy for Rapid Enlargement of Hibernating Coronary Arteriovenous Fistulas

Shizu Oyamada, MDa, Junjiro Kobayashi, MDa, Osamu Tagusari, MDa,*, Kazuo Niwaya, MDa, Hiroyuki Nakajima, MDa, Shunichi Miyazaki, MDb, Kohji Kimura, MDc, Shigeyuki Echigo, MDd, Soichiro Kitamura, MDa

a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
b Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan
c Department of Radiology, National Cardiovascular Center, Osaka, Japan
d Department of Pediatrics, National Cardiovascular Center, Osaka, Japan

Accepted for publication October 2, 2006.

* Address correspondence to Dr Tagusari, National Cardiovascular Center, Cardiovascular Surgery, 5-7-1 Fujishirodai, Suita, Osaka 565-8565 Japan (Email: otagusar{at}hsp.ncvc.go.jp).

The use of hybrid therapy for recurrent multiple coronary arteriovenous fistulas in a 56-year-old woman is reported. The patient underwent surgical closure of a coronary arteriovenous fistula of the right coronary artery under cardiopulmonary bypass at 47 years of age. Reoperation was required 9 years later for recurrence of the same fistula. It was divided under a beating heart. Early postoperative angiography showed complete occlusion of the right coronary fistula. However, hibernating fistulas of the left circumflex artery, which had been left untouched because of insignificant shunt with no remarkable change for 9 years, increased in size rapidly. Transcatheter embolization was successfully performed for these residual fistulas.







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