INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF CORONARY-ARTERY FISTULAS

Coronary artery fistula is a rare abnormality but one with substantial surgical importance, as operation abolishes the fistulous shunt volum e, progressive coronary dilatation, and potential coronary steal. Prio r reports emphasize the utility of direct inspection on cardiopulmonar y bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 pa tients in whom intraoperative transesophageal echocardiography was use d for precise localization of the fistulous drainage site, selective d emonstration of vessels feeding the fistulas, and documentation of abo lition of fistulous flow, all without need for cardiopulmonary bypass. In addition, the technique provides for continuous monitoring of vent ricular function, providing the opportunity to detect inadvertent isch emic effects of ligation. This approach appears to have considerable u tility.