Coronary Artery Fistula to Pulmonary Artery: Coronary-Dependent Pulmonary Circulation Neeraj Awasthy, MD, FNB, Sitaraman Radhakrishnan, DM, Krishna Subramaniyam Iyer, MCH, and Apoorav Goel, MD Department of Pediatric Cardiology, Department of Cardiac Surgery, and Department of Radiodiagnosis, FEHI, Delhi, India
FEATURE ARTICLES
Fig 1.
I
n pulmonary atresia, the pulmonary vascular bed is fed by a ductus arteriosus, aortopulmonary collaterals, aortopulmonary window, or very rarely by a coronary artery to pulmonary artery fistula. An 11-year-old boy presented with exertional dyspnea and cyanosis. On examination the child had an oxygen saturation of 84%, and a continuous murmur was audible at the second left intercostal space. Transthoracic echocardiography revealed a fossa ovalis atrial septal defect, a nonrestictive perimembranous ventricular septal defect shunting right to left, single outflow pulmonary atresia, and confluent branch pulmonary arteries. The right main coronary artery was dilated, with suspicion of a collateral feeding the main pulmonary artery with a continuous Doppler signal. Computerized tomographic angiography showed a large fistula measuring 6.5 mm arising from the right coronary artery ostium and supplying the main pulmonary artery (Figs 1, 2; LPA ¼ left pulmonary artery; MPA ¼ main pulmonary artery; RCA ¼ right coronary
Address correspondence to Dr Awasthy, Department of Pediatric cardiology, FEHI, Delhi, India 110025; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 2.
artery; RPA ¼ right pulmonary artery). The child underwent surgical correction with closure of the ventricular septal defect, division of the fistula, and placement of a valved conduit, 22 mm in diameter, from the right ventricle to the pulmonary artery. The child had a smooth postoperative course. Follow-up echocardiography at 6 months showed laminar flow in conduit, mild pulmonary regurgitation, and no residual fistula or abnormal ventricular function.
Ann Thorac Surg 2014;97:716 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.06.096
FEATURE ARTICLES
Fig 1.
I
n pulmonary atresia, the pulmonary vascular bed is fed by a ductus arteriosus, aortopulmonary collaterals, aortopulmonary window, or very rarely by a coronary artery to pulmonary artery fistula. An 11-year-old boy presented with exertional dyspnea and cyanosis. On examination the child had an oxygen saturation of 84%, and a continuous murmur was audible at the second left intercostal space. Transthoracic echocardiography revealed a fossa ovalis atrial septal defect, a nonrestictive perimembranous ventricular septal defect shunting right to left, single outflow pulmonary atresia, and confluent branch pulmonary arteries. The right main coronary artery was dilated, with suspicion of a collateral feeding the main pulmonary artery with a continuous Doppler signal. Computerized tomographic angiography showed a large fistula measuring 6.5 mm arising from the right coronary artery ostium and supplying the main pulmonary artery (Figs 1, 2; LPA ¼ left pulmonary artery; MPA ¼ main pulmonary artery; RCA ¼ right coronary
Address correspondence to Dr Awasthy, Department of Pediatric cardiology, FEHI, Delhi, India 110025; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 2.
artery; RPA ¼ right pulmonary artery). The child underwent surgical correction with closure of the ventricular septal defect, division of the fistula, and placement of a valved conduit, 22 mm in diameter, from the right ventricle to the pulmonary artery. The child had a smooth postoperative course. Follow-up echocardiography at 6 months showed laminar flow in conduit, mild pulmonary regurgitation, and no residual fistula or abnormal ventricular function.
Ann Thorac Surg 2014;97:716 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.06.096
