An atypical coronary artery fistula originated from right
coronary sinus of Valsalva with anomalous Left circumflex artery origin
Zixin Xie1,2, Xiaojun Xie1,2,
Banghui Lai1,2, Mingbin Deng1,2*
1 Department of Cardiovascular
Surgery, The Affiliated Hospital Of
Southwest Medical University, 8 Kangcheng Road, Jiangyang District,
Luzhou 646000, P.R. China.
2Cardiovascular and Metabolic Diseases Key Laboratory
of Luzhou.
*Corresponding
author:
Mingbin Deng, E-mail: mingbindeng@126.com.
Telephone:
+8613608288599
A 14-year-old male was referred to our institution because of a
continuous heart murmur diagnosed at another hospital. Physical
examination revealed stable vital signs and a continuous murmur at the
mid-left sternal border. The remainder of the examination was
unremarkable. The electrocardiogram was normal with no ischemic changes.
Cardiac markers were insignificant. Transthoracic echocardiography
showed normal left ventricular motion and no valvular disease.
Cardiac
doppler showed a continuous turbulent flow into the right atrium(Panel
A). Multidetector computed tomography(MDCT) revealed an abnormal marked
dilation vessel originating from the right coronary sinus of Valsalva.
The abnormal vessel developed into a 35 ×29 mm tortuosity aneurysm and
eventually flowed into the posterior aspect of the right atrium(Panels B
and D). The origin and diameter of the entire RCA were normal(Panel C).
In addition, an anomalous origin of left circumflex artery(LCx) from the
right coronary sinus of Valsalva was noted(Panels B and C). Because of
the presence of a large fistulous tract and rupture risk, the patient
was considered a surgical candidate. The fistula is identified from
within the right atrium. The aneurysm wall was resected, and the stump
was closed with direct sutures. The postoperative morphology of the
sinus of Valsalva was excellent, and aortic regurgitation was not
observed.
Coronary artery fistula(CAF) is defined as a rare congenital or acquired
abnormal communication between the coronary arteries and a cardiac
chamber or a thoracic great vessel 1. The most common
clinical presentation of CAF in children is a persistent heart murmur.
Because CAF in children tends to increase with age, early surgical
correction is required 2. Coronary artery fistulas can
originate from any coronary artery branch 3. However,
for this patient, the CAF originated from the right coronary sinus of
Valsalva, which mimicking a Sinus of Valsalva aneurysm, there was no
remarkable enlargement of right coronary sinus.