Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography

Coronary artery fistula is a rare congenital malformation that can be compl icated by intracardiac shunts, endocarditis, myocardial infarction, coronar y aneurysm and sudden death. Clinical symptomatology depends upon the under lying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant rig ht coronary artery with fistulisation into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for pre cise location of the fistulous communication, selective demonstration of ve ssels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Futhermore the effect of s hunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula. (C) 1999 Elsevier Science B.V. All rig hts reserved.