Coronary Arteriovenous Fistula Causing Significant Left-to-Right Shunt
A 27-year-old woman was referred to our hospital for cardiac catheterization with a diagnosis of atrial septal defect. She had been well until 2 years earlier, when she started to experience increasing fatigue and shortness of breath. On physical examination, a soft systolic murmur was heard over the left sternal border. Echocardiography revealed an enlarged coronary sinus, and the interatrial septum was intact. Cardiac catheterization showed a 2.0:1.0 left-to-right shunt at the level of the right atrium. During left ventriculography at the time of cardiac catheterization, a large vascular structure apart from the aorta was faintly visualized. Subsequently, an aortic root angiogram demonstrated a gigantic right coronary artery that drained into the coronary sinus (Figure 1). The patient underwent open-heart surgery several weeks later. The gigantic right coronary artery, which did not give any significant branches (Figure 2), was ligated. The patient had an uneventful hospital course and was discharged 1 week after the operation. At 6-month follow-up, she was free of complaints, and her physical examination was normal.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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