In:
Hospital Medicine, Mark Allen Group, Vol. 61, No. 2 ( 2000-02), p. 140-141
Abstract:
A48-year-old woman presented with increasing breathlessness on exertion. A continuous murmur had been noted 6 years earlier and attributed to a patent ductus arteriosus. At referral, examination revealed a systolic murmur (2/6) continuing across the second sound into late diastole (1/4), audible at the left sternal edge. Her electrocardiogram showed sinus rhythm, a normal axis and non-specific ST changes in the inferior leads. A transthoracic echocardiogram demonstrated impaired left ventricular function, most marked in the anterior wall, and a well circumscribed area of turbulent flow in the region of the interatrial septum but no shunt at this level (using Doppler and colour coding). These findings were suggestive of a vessel running through the interatrial septum which was subsequently confirmed using transoesophageal echocardiography (Figures 1 and 2). Running a tortuous course from its origin at the left main coronary artery, through the interatrial septum to drain into the right atrium, the serpiginous appearance of the vessel was typical of a coronary artery fistula. The left ventricular hypokinesia and fistula were confirmed at cardiac catheterization but no additional atherosclerotic disease was demonstrated. A thallium perfusion scan, including adenosine vasodilation, failed to demonstrate any perfusion defect. Nonetheless the left coronary artery to right atrial fistula and left ventricular impairment suggested the patient's symptoms were a function of inadequate myocardial perfusion resulting from coronary artery steal and the patient was referred for surgical ligation. At surgery a 1 cm fistulous dilatation of the left main stem of the left coronary artery was found: the fistula then coursed over the roof of the left atrium and down through the interatrial septum to drain into the right atrium. The fistula was ligated as it crossed over the roof of the left atrium. The patient made an uneventful postoperative recovery. When assessed several months later her symptoms had fully resolved and repeat echocardiography confirmed normal left ventricular function.
Type of Medium:
Online Resource
ISSN:
1462-3935
,
2053-4299
DOI:
10.12968/hosp.2000.61.2.2402
Language:
English
Publisher:
Mark Allen Group
Publication Date:
2000
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