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Left main coronary artery aneurysm with a fistula draining into the right atrium
Author(s) -
Jacobsen Kristina,
Khouzam Nayer
Publication year - 2018
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13960
Subject(s) - medicine , right atrium , aneurysm , cardiology , fistula , left atrium , coronary artery aneurysm , atrium (architecture) , artery , radiology , atrial fibrillation , kawasaki disease
Coronary artery aneurysms may develop fistulas which drain into the pulmonary artery and the left ventricle. We present images of a patient with a left main coronary artery aneurysmwhich fistulized into the right atrium (RA). A 38-year-old Asian female presented with a cough and fatigue. A chest X-ray revealed a mass abutting the right heart border (Figure 1). A transesophageal echocardiogram (TEE) demonstrated a large coronary artery aneurysm communicating with the RA (Figure 2). A computed tomography angiogram revealed a left main coronary artery aneurysm, 9.6 × 9.7 × 9.2 cm, extending into the left circumflex artery compressing the right main pulmonary artery, with a 1.5-cm fistulous vessel overlying the dome of the left atrium (Figures 3 and 4). A cardiac catheterization revealed a left main coronary artery aneurysm with a fistulous vessel overlying the right ventricle (RV) (Figure 5). The pulmonary artery pressures were 48/23mmHg and there was evidence of mild left-to-right shunting (QP/QS = 1.3:1). At the time of surgery, a median sternotomy revealed dense pericardial adhesions to the RA and RV. A large left coronary artery aneurysm was found to be encasing the RA free wall and extending toward the superior vena cava. Cardiopulmonary bypass (CPB) was