Computer Tomography of Bilateral Congenital Coronary Artery Fistulae
Daljeet S. Gill, Gregory Kaw, Kheng-Siang Ng
The Heart Institute, Tan Tock Seng Hospital, Singapore
A 37-year-old man presented a fever and streptococcus viridans septicaemia. Transoesophageal echocardiography showed an enlarged left main stem (LMS) and circumflex artery (Panel A) and a dilated coronary sinus (CS, Panel B). These findings were suggestive of a left circumflex artery to coronary sinus fistula. The cardiac computer tomography (CT) scan however showed the presence of a bilateral congenital coronary artery fistula arising from the left circumflex and the right coronary arteries and draining into the coronary sinus.
Panel C shows a CT image at the origin of the left main coronary artery. The left main (arrow) and circumflex arteries (arrowhead) are dilated. Panel D shows a CT image of a dilated and tortuous circumflex artery (white arrow) draining into the coronary sinus (black arrow). The site of drainage of the coronary sinus into the right atrium is marked with an asterisk. Panel E shows a convoluted right coronary artery (arrow) draining into the coronary sinus (asterisk).
Coronary angiography (Panel F) confirmed the presence of a large right coronary artery (RCA) and a giant left circumflex (LCX) draining via a tortuous fistulous tract into the coronary sinus.
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