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Interact CardioVasc Thorac Surg 2009;9:124-126. doi:10.1510/icvts.2009.203489
© 2009 European Association of Cardio-Thoracic Surgery
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Balakrishnan Mahesh
Manoraj Navaratnarajah
Kwabena Mensah
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Case report - Cardiac general

Treatment of high-output coronary artery fistula by off-pump coronary artery bypass grafting and ligation of fistula

Balakrishnan Mahesh*, Manoraj Navaratnarajah, Kwabena Mensah and Mohamed Amrani

Center for Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, UK

*Corresponding author. Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK. Tel.: +44-1603-286286.

E-mail address: drbmahesh{at}googlemail.com (B. Mahesh).

Coronary artery fistulas (CAF) are uncommon entities often associated with myocardial ischemia and high output failure. Surgical options include ligation of the fistula, with/without simultaneous coronary artery bypass grafting (CABG). We report a case of left main coronary artery (LMCA) fistula to the coronary sinus (CS), which was associated with high-output bi-ventricular failure, and moderate mitral (MR) and tricuspid regurgitation (TR), related to the volume overload and annular dilatation. This was tackled elegantly by off-pump CABG to protect the territories supplied by the LMCA, followed by ligation of the fistula. This resulted in resolution of the MR and TR. Intraoperative transesophageal echocardiogram (TEE) greatly facilitated the surgical treatment, by identifying the origin and the draining points for the fistula, and aided in the quantification of MR and TR, which had regressed sufficiently at the end of the procedure and did not require surgical correction. This article outlines the importance of multi-disciplinary treatment approach for this complex condition.

Key Words: Coronary artery fistula; Off-pump coronary revascularization; Mitral regurgitation; Coronary revascularization

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