Korean Circ J.  2012 Nov;42(11):792-795. 10.4070/kcj.2012.42.11.792.

Congenital Giant Right Coronary Artery Aneurysm With Fistula to the Coronary Sinus and Persistent Left Superior Vena Cava in an Old Woman

• Lee SY
• Park YH
• Yeo HJ
• Sohn CB
• Han DC
• Kim JS
• Kim J
• Kim JH
• Chun KJ

• KMID: 2224983
• DOI: http://doi.org/10.4070/kcj.2012.42.11.792

Abstract

The combination of coronary arteriovenous fistula to the coronary sinus (CS), dilatation of the entire length of coronary artery, coronary aneurysm and persistent left superior vena cava (PLSVC) is very rare. We present the case of a 63-year-old female admitted for dyspnea on exertion, orthopnea, and facial edema. Echocardiography detected a giant coronary artery with shunt flow, dilated CS and PLSVC and a coronary angiography reaffirmed these findings. The calculated ratio of pulmonary blood flow to systemic blood flow by cardiac catheterization was 1.53. After multidisciplinary review considering old age, hypoactivity due to underlying Parkinsonism and relatively small amount of shunt flow, medical therapy was chosen. The patient remained asymptomatic for 10 months after discharge without intervention.

Keyword

Coronary aneurysm; Arteriovenous fistula; Coronary sinus

MeSH Terms

Aneurysm
Arteriovenous Fistula
Cardiac Catheterization
Cardiac Catheters
Coronary Aneurysm
Coronary Angiography
Coronary Sinus
Coronary Vessels
Dilatation
Dyspnea
Echocardiography
Edema
Female
Fistula
Humans
Middle Aged
Parkinsonian Disorders
Vena Cava, Superior

Figure

• 

  Fig. 1 Transthoracic echocardiography. A: posteriorly angulated apical four-chamber view showed tortuous aneurysmal dilatation of right coronary artery (asterisk) terminating into the coronary sinus (arrow). B: color flow imaging showed shunt flow from the right coronary artery (asterisk) into the coronary sinus (arrow). C: continuous-wave Doppler demonstrated shunt flow throughout whole cardiac cycle with high velocity (4 m/sec). Ao: aorta, CS: coronary sinus, LV: left ventricle, RV: right ventricle.

• 

  Fig. 2 Volume-rendenered 3-dimensional images of multidetector computed tomography angiogram. A: giant right coronary artery (asterisk); PLSVC (arrow) and left innominate vein ran below the aortic arch (arrow head). B: giant right coronary artery from the initial segement (asterisk); A serpentine coronary artery formed a round mass at the distal end with an opening to the coronary sinus (arrow). An: aneurysm, Ao: aorta, PA: pulmonary artery, PLSVC: persistent left superior vena cava.

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  Fig. 3 Angiography. A: venography with catheterization via coronary sinus to PLSVC (asterisk). B: coronary angiography with pigtail catheter showed the large and tortuous RCA, CS and PLSVC filled with contrast material. Arrow indicates the confluence of PLSVC and RCA to CS. C: drawing elucidating angiographic findings. INN: innominate vein, PLSVC: persistent left superior vena cava, An: aneurysm, Ao: aorta, CS: coronary sinus, IVC: inferior vena cava, PA: pulmonary artery, RA: right atrium, RCA: right coronary artery, RV: right ventricle, SVC: superior vena cava.

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