From the Division of Cardiology, CHUV, Lausanne, Switzerland.
Correspondence to Prof J.J. Goy, Division of Cardiology, CHUV, 1011 Lausanne, Switzerland.
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.
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
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Giant Coronary Fistula
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Figure 1. A, Transverse echocardiographic view of aorta
(Ao) and ostium of dilated left coronary artery (LCA). B,
Aortography (lateral view) showing normal right coronary artery
and the udged left anterior descending coronary artery ending
in the right ventricle.