Case ConferencesCase 3—2001: Multiplane transesophageal echocardiography in minimally invasive surgery for coronary artery fistula*
Section snippets
Case presentation*
A 74-year-old woman presented for surgical clipping of a coronary artery fistula (CAF). Her medical history included hypertension for which she was treated with amlodipine, and she was a type 2 diabetic under long-term treatment with gliclazide. The patient experienced angina and dyspnea on exertion for 4 months. Treatment was started with acetylsalicylic acid, bisoprolol, and molsidomine. Over the last 2 weeks, her symptoms were worsening. Auscultation revealed a protomesosystolic murmur in
Discussion†
CAF is an infrequent congenital anomaly. It is noted in approximately 1 in 500 coronary angiographic examinations. It involves the right coronary artery in approximately 50% of patients, the left coronary artery in approximately 42%, and both in approximately 5% of patients.1, 2, 3, 4
Aortography with selective coronary angiography is still the diagnostic mode of choice. Several studies have shown, however, that multiplane TEE is the noninvasive mode of choice in patients with a CAF.1 It
Commentary‡
The use of intraoperative TEE during cardiac surgery is increasing rapidly as a result of its perceived impact on surgical and anesthetic decision making. The use of intraoperative TEE in the case presented here contributed to the diagnosis of cardiac pathology and ultimately influenced the management of these patients. As the popularity of intraoperative TEE increases, however, its impact on surgical and anesthesia decision making and clinical outcome as well as its role as a monitoring and
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Cited by (3)
Asymptomatic aorto-atrial fistula identified with intraoperative transesophageal echocardiography
2012, Journal of Cardiothoracic and Vascular AnesthesiaIntraoperative imaging and off-pump ligation of coronary artery fistula
2012, Journal of Cardiothoracic and Vascular AnesthesiaGender-related differences in octogenarians with congenital coronary artery fistula: A report of two cases and a review
2011, Netherlands Heart Journal
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Address reprint requests to S. Bouchez, MD, Department of Anesthesiology, O. L. Vrouw Clinic, Aalst, Belgium.