Giant Coronary Fistula
This African 3-year-old boy had had a systolic and diastolic murmur of 3/6 maximal at the left midsternal border in the neonatal period. He was diagnosed with a patent ductus arteriosus. At time of surgery, no ductus was found. Because the murmur was still present after the operation, the patient was sent to our institution for further investigations. He was asymptomatic, and blood pressure was 135/90. The chest radiograph was normal. Mild right ventricular hypertrophy was noted on the ECG. The echocardiogram showed no ductus, but the ostium of the left coronary artery was dilated (6 mm in diameter) (A), and this artery ended in the apex of the right ventricle. A continuous flow between this artery and the right ventricle was documented. Aortic angiography confirmed the suspected coronary artery–to–right ventricle fistula (B). The fistula was ligated distally. The postoperative course was uncomplicated, and the child was discharged on day 7. Cardiac auscultation was normal, and a postoperative echocardiogram did not show any abnormal continuous flow.
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.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association