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(Circulation. 1999;99:2827-2828.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Arteriovenous Fistulas of the Circumflex and Right Coronary Arteries With Drainage Into an Aneurysmal Coronary Sinus

André J. Duerinckx, MD, PhD; Joseph K. Perloff, MD; Jesse W. Currier, MD

From the Radiology Service, West Los Angeles Veterans Administration Medical Center, and the UCLA Adult Congenital Heart Disease Center, UCLA Center for Health Sciences, Los Angeles, Calif.

Correspondence to André J. Duerinckx, MD, PhD, Radiology Service (Mail Route W114), MRI, Building 507, West Los Angeles VA Medical Center, 11301 Wilshire Blvd, Los Angeles, CA 90073. E-mail ajd@ucla.edu

The images presented here are from a 44-year-old asymptomatic man. At age 36 years, he experienced nonsustained atrial fibrillation. A year later, a transthoracic echocardiogram disclosed an enlarged left ventricle (diastolic dimension, 7.4 cm; ejection fraction, 56%) and a very large coronary sinus with Doppler color flow evidence of diastolic and systolic turbulence consistent with entry of a coronary arteriovenous fistula. Current selective coronary angiography visualized dilated circumflex and right coronary arteries, both of which entered an aneurysmal coronary sinus. An MRI during breath-hold acquisition further delineated the enlarged coronary sinus into which the circumflex and right coronary arteries drained (Figure 1). A 3-dimensional (3D) image set was then obtained by sequential MRI acquisitions during repeated breath-holding with surface reconstructions (Figure 2). The diameter of the proximal right coronary artery was 10 mm, and the diameter of the left main coronary artery was 11 mm (Figure 2, left). The circumflex artery was 11 mm in its proximal diameter, then abruptly widened to 18 to 20 mm and became very tortuous (Figure 2, left). The left anterior descending artery, by contrast, was 5 to 6 mm in diameter. The enlarged coronary sinus measured 8.5x4.5x3.5 cm (Figure 2, right) and compressed the inferior portion of the left atrium. These images assisted in planning surgical closure of the coronary arteriovenous fistulas, at which time the right atrial appendage with a portion of the enlarged right atrium was excised and a maze procedure was performed. . . . [Full Text of this Article]