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European Heart Journal Advance Access originally published online on April 24, 2008
European Heart Journal 2008 29(20):2472; doi:10.1093/eurheartj/ehn175
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

A fistula from the coronary artery into the right atrium caused by transseptal puncture

Akira Tamura*, Shigeru Naono and Junichi Kadota

Second Department of Internal Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu 879-5593, Japan

* Corresponding author. Tel: +81 97 586 5804, Fax: +81-97-549-4245, Email: akira{at}med.oita-u.ac.jp

A 46-year-old woman with mitral stenosis was admitted to our hospital because of exertional dyspnea. She had undergone open mitral commissurotomy 15 years ago. Doppler echocardiography showed that the mitral valve area was 0.8 cm2 without mitral regurgitation. She underwent diagnostic cardiac catheterization including transseptal puncture. After several attempts of the transseptal puncture, a Brockenbrough's needle was successfully advanced into the left atrium. The pressure gradient in the diastolic phase between the left atrium and the left ventricle was 10 mmHg, and the mitral valve area calculated by the Gorlin formula was 0.8 cm2. Coronary angiography performed after the transseptal puncture revealed a fistula from the atrial branch in the left circumflex coronary artery into the right atrium (RA) (Panels A and B, white arrows). A significant step-up in the O2 saturation was not observed in the RA, and echocardiography did not showed echo free space. After 1 week, she successfully underwent percutaneous mitral valvuloplasty using an Inoue balloon without any complications. Because the fistula did not produce any adverse effects, including a coronary steel phenomenon, we decided to perform conservative management for it. To the best of our knowledge, this is the first report of a coronary-RA fistula caused by the transseptal puncture.

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This Article
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29/20/2472    most recent
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