Cardiac tamponade due to rupture of coronary artery fistula to the coronary sinus with giant aneurysm of coronary artery
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CASE REPORT
Cardiac tamponade due to rupture of coronary artery fistula to the coronary sinus with giant aneurysm of coronary artery: usefulness of transthoracic echocardiography Satoshi Yoshino • Shinichi Minagoe • Bo Yu • Ippei Kosedo • Makoto Yamashita • Munesumi Ishizawa Mihoko Kono • Manabu Setoguchi • Hitoshi Nakashima • Tatsuru Matsuoka • Shoichi Suehiro • Goichi Yotsumoto • Masafumi Yamashita • Chuwa Tei
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Received: 8 February 2012 / Accepted: 10 August 2012 / Published online: 3 November 2012 Ó Springer 2012
Abstract A 68-year-old woman was admitted to our hospital because of back pain and syncope. Transthoracic echocardiography revealed pericardial effusion, a collapsed right ventricle, a giant aneurysm connected to the coronary sinus, a dilated left main trunk coronary artery, and a dilated left circumflex artery (LCx). Furthermore, there was a coronary artery fistula arising from the LCx that drained into the coronary sinus. We diagnosed cardiac tamponade due to rupture of the coronary artery fistula or giant aneurysm, and successful emergency surgery was performed. Rupture of coronary artery aneurysm or coronary artery fistula is very rare. Transthoracic two-dimensional echocardiography was very useful in our case for the diagnosis of cardiac tamponade, giant coronary aneurysm, and coronary artery fistula.
Keywords Coronary artery fistula Giant coronary aneurysm Cardiac tamponade Transthoracic two-dimensional echocardiography
Introduction
S. Yoshino S. Minagoe (&) B. Yu I. Kosedo M. Yamashita M. Ishizawa M. Kono M. Setoguchi H. Nakashima T. Matsuoka The First Division of Cardiology, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama, Kagoshima 892-0853, Japan e-mail: [email protected]
Coronary artery aneurysm has been found incidentally during coronary angiography [1], and rupture of coronary artery aneurysm or coronary artery fistula is very rare. Fistulous communication of an aneurysmal circumflex coronary artery to the coronary sinus has been previously reported as an extremely rare coronary artery anomaly [2]. Coronary angiography, magnetic resonance imaging, and transesophageal echocardiography are essential for establishing the diagnosis. Newer imaging modalities, such as multidetector-row computed tomography (MDCT), can be useful for demonstrating coronary artery fistula noninvasively [3]. In addition, transthoracic two-dimensional (2D) echocardiography may be useful for the diagnosis of giant coronary aneurysm and coronary artery fistula, as well as cardiac tamponade due to rupture of the fistula or aneurysm. We report a case of ruptured coronary fistula in a patient who underwent successful emergency surgery. Furthermore, we describe the usefulness of transthoracic 2D echocardiography in detecting a giant aneurysm of a coronary artery and a coronary artery fistula from the left circumflex artery (LCx) to the coronary sinus.
S. Suehiro G. Yotsumoto M. Yamashita Department of Cardiovascular Surgery, National Hospital Organization Ka
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