Korean Circ J.  2013 May;43(5):356-359. 10.4070/kcj.2013.43.5.356.

A Rare Combination of the Left Circumflex Coronary Artery Fistula Connecting a Dilated Coronary Sinus with Persistent Left Superior Vena Cava and Multiple Arteriovenous Fistulae

• Yeon MH
• Choi YR
• Lee SY
• Bae JW
• Hwang KK
• Kim DW
• Cho MC
• Kim SM

• KMID: 2224938
• DOI: http://doi.org/10.4070/kcj.2013.43.5.356

Abstract

Coronary artery fistula (CAF) is an abnormal communication between an epicardial coronary artery and a cardiac chamber, major vessel or other vascular structures. This report presents a rare case of CAF in which a dilated left main trunk and proximal circumflex coronary artery are connected to a dilated coronary sinus. There were also two other fistulae and persistent left superior vena cava. The coronary fistula was managed conservatively.

Keyword

Coronary vessel anomalies; Arteriovenous fistula; Coronary sinus

MeSH Terms

Arteriovenous Fistula
Coronary Sinus
Coronary Vessel Anomalies
Coronary Vessels
Fistula
Glycosaminoglycans
Vena Cava, Superior
Glycosaminoglycans

Figure

• 

  Fig. 1 Echocardiographic findings. A: echocardiography shows a dilated coronary sinus. B: echocardiography shows a dilated left main coronary artery and abnormal color flow at the pulmonary valve level. Arrow indicating left main trunk and turbulent flow. LV: left ventricle, CS: coronary sinus, LA: left atrium, Ao: aorta.

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  Fig. 2 Coronary angiography. Coronary angiography showing aneurysmal tortuous dilation of circumflex coronary artery and PLSVC. Arrow indicating dilated left main coronary artery. The exact drainage site of coronary artery fistula is not clearly identified. PLSVC: persistent left superior vena cava.

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  Fig. 3 A computed tomogram angiography. A: a coronal image from CT angiogram showing PLSVC. White arrow indicating the left bronchial artery, which originates from the descending aorta. B: an axial image from CT angiogram showing the left anterior descending coronary artery (black arrow), the tortuous fistula originating from the left circumflex coronary artery (*), the fistula originating from the sinoatrial nodal artery (white arrowhead), the fistula arising from the RCA and draining into the PT (white dotted arrow), termination of the left bronchial artery (white arrow). C: the white dotted arrow indicate conal branch originating from the RCA draining into the PT. D: an axial image from CT angiogram showing extremely tortuous left bronchial artery originate from the descending aorta (white dotted arrow). PLSVC: persistent left superior vena cava, LV: left ventricle, PA: pulmonary artery, IVC: inferior vena cava, PT: pulmonary trunk, Ao: aorta, LV: left ventricle, RCA: right coronary artery.

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