MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF CONGENITAL CORONARY-ARTERY FISTULA

The purpose of this study was to examine the advantages of multiplane transesophageal echocardiography in the diagnosis of congenital corona ry artery fistula, specifically in depicting the origin, the course, a nd the drainage site. Seven consecutive patients ranging in age from 2 0 to 72 years with a suspected coronary artery fistula underwent conve ntional transthoracic and multiplane transesophageal echocardiographic studies between March 1993 and July 1994. When a coronary artery fist ula was noted, the origin, the course, and the drainage site were care fully searched for. All patients then underwent a cardiac catheterizat ion with the performance of coronary angiography. A large right corona ry artery fistula was detected in three patients; one of them had a dr ainage to the posterior left ventricle, one to the lateral right ventr icle, and the other to the medial aspect of the right ventricle just b elow the insertion of the septal leaflet of the tricuspid valve. A sma ll coronary artery fistula arising from the left coronary artery was n oted in four patients, two from the left anterior descending artery an d the other two from the left circumflex artery. Three of these four p atients had a drainage to the main pulmonary artery and one to the lef t ventricle. The drainage site was dearly depicted in all seven patien ts, whereas the origin and the course were precisely defined in five p atients by using multiplane transesophageal echocardiographic examinat ion. The multiplane transesophageal echocardiography provides a panora mic view of the coronary artery and the fistulous vessel with a precis e definition of the origin, the course, and the drainage site of the f istula. Therefore it is the noninvasive diagnostic mode of choice.