(Circulation. 1998;97:499-500.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Sinus Node Artery Fistula
Linda R. Peterson, MD;
Lowell F. Peterson, MD;
Trevor A. Rattray, MD;
; James E. Quillen, MD
From Washington University School of Medicine, St Louis, Mo, and the
Appleton Heart Institute, Appleton, Wis.
Correspondence to Linda R. Peterson, MD, Washington University School of Medicine, 660 S Euclid Ave, Box 8086, St Louis, MO 63110.
A 54-year-old
asymptomatic white man had the chest radiographs and scan
shown in Figures
performed as part of an insurance physical
examination.
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Figure 2. Anteroposterior chest radiograph. White arrows
point to round, calcified abnormality seen on lateral chest
radiograph.
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Figure 4. Ventriculogram (right anterior oblique
projection). White arrow points to calcified abnormality, which is
posterior to ascending aorta.
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Figure 5. Angiogram of patient's right coronary
artery (right anterior oblique view). White arrows point to calcified
abnormality seen on chest radiograph and CT. Tip of catheter is down
past takeoff of sinus node artery.
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Figure 6. A. A selective injection of the sinus node artery
fistula, through the round, calcified abnormality seen on flouroscopy.
The thick white arrows point to the calcified area, and the thin white
arrows show the flow from the sinus node artery into the right atrium.
B. Another selective injection of the sinus
node artery fistula with the white arrow pointing to the flow into the
right atrium.
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A decision was made with the patient to remove the fistula
because of the risk of endocarditis, an increase in left-to-right shunt
flow, and the risk of coronary steal. The patient tolerated the
procedure extremely well and remained in sinus rhythm after surgery. A
sinus node artery fistula is a very rare condition. The exact cause of
the fistula in this patient is most likely congenital, because the
patient had no history of major trauma or endocarditis.
Footnotes
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 McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
