Intraoperative transesophageal echocardiography of coronary artery fistulas

• Published in: The Annals of thoracic surgery Vol. 57; no. 5; pp. 1217 - 1221
• Main Authors: Stevenson, J.Geoffrey, Sorensen, Gregory K., Stamm, Stanley J., McCloskey, John P., Hall, Dale G., Rittenhouse, Edward A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1994; Elsevier Science
• Subjects: Biological and medical sciences; Child, Preschool; Coronary Angiography; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - surgery; Echocardiography, Doppler; Echocardiography, Transesophageal; Female; Fistula - congenital; Fistula - diagnostic imaging; Fistula - surgery; Humans; Infant; Intraoperative Period; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Sonography; Case study; Human; Echocardiography; Surgery; Coronary artery; Cardiovascular disease; Exploration; Intraoperative; Fistula; Coronary heart disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(94)91360-9

Coronary artery fistula is a rare abnorm lity but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 patients in whom intraoperative transesophageal echocardiography was used for precise localization of the fistulous drainage site, selective demonstration of vessels feeding the fistulas, and documentation of abolition of fistuloua flow, all without need for cardiopulmonary bypass. In addition, the technique provides for continuous monitoring of ventricular function, providing the opportunity to detect inadvertent ischemic effects of ligation. This approach appears to have considerable utility.