Ann Thorac Surg 1999;67:598-599
© 1999 The Society of Thoracic Surgeons
Correspondence
Congenital coronary-to-pulmonary artery fistulas: 22 months after repair
Mosen Alavi, MDa,
Andrew S. Olearchyk, MDa
a Sections of Cardiology Cardiothoracic Surgery, Episcopal Hospital, 100 E Lehigh Ave, Philadelphia, PA 19125 USA
Coronary artery proximal to a significant coronary-to-pulmonary artery fistula (CPAF) is dilated because of increased blood flow [1]. What happens to that dilatation after ligation of the fistula? Does the dilatation remain the same, or does it progress to aneurysmal formation, or does it decrease?
A 63-year-old woman complained of recent onset of exertional precordial pain. On November 27, 1996, she underwent proximal ligation of congenital fistulas originating from the proximal right coronary artery and the distal left main coronary artery and draining to the main pulmonary artery on a beating heart [1]. The heart rate was regular at 70 beats/min; blood pressure was 120/70 mm Hg; the midsternotomy incision was well healed; and there was no precordial thrill or murmur.
Repeat cardiac catheterization (September 24, 1998) (Fig 1) showed a dominant right coronary artery with no evidence of the previously demonstrated CPAFs originating from its proximal portion, minimal luminal irregularities, and narrowing of the lumen by less than 30% in its middle portion; decreased dilatation of the entire left main coronary artery and the proximal portion of the left anterior descending coronary artery without the fistula; a normal circumflex artery; and normal hemodynamic variables. No stumps were seen at the sites of the proximal ligation of the fistulas.
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Fig 1. Selective injection of dye into the left main coronary artery in the right anterior oblique projection shows decreased dilatation of the left main coronary artery and the proximal portion of the left anterior descending coronary artery, without the previously demonstrated fistulas to the main pulmonary artery.
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Twenty-two months earlier, this patient had undergone ligation of congenital bilateral CPAFs on a beating heart. Repeat cardiac catheterization was subsequently performed because of precordial pain and to exclude the possibility of aneurysm formation in a previously demonstrated dilated left main coronary artery that could result in thrombus formation and microembolization and to rule out the development of significant coronary artery disease in the meantime. The dilatation of the left main and proximal left anterior descending coronary arteries has since decreased.
References
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Olearchyk A.S., Runk D.M., Alavi M., et al. Congenital bilateral coronary-to-pulmonary artery fistulas. Ann Thorac Surg 1997;64:233-234.[Abstract/Free Full Text]
