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Minimally Invasive Surgical Closure Of Coronary Cameral Fistula
Lisardo Garcia;
Christus Good Shepherd Heart and Vascular Institute/Texas A& M University School of Medicine, Longview, Texas, TX, USA
Background: Coronary artery fistulae (CAF) are abnormal communications between the coronary arteries and adjacent structures. A coronary cameral fistula is an abnormal communication existing between a coronary artery and any cardiac chamber. They are present in less than 1% of the population and in 0.1 to 0.2% coronary angiographies. Most CAF are small, asymptomatic, do not cause any complications and resolve spontaneously. Large fistulae require transcatheter or surgical closure. According to the literature, median sternotomy has been the traditional approach for surgical closure. Herein we present an elderly female with a large symptomatic coronary cameral fistula draining into the right atrium that was surgically closed via a right mini thoracotomy.
Methods: A 69-year-old woman was evaluated for progressive shortness of breath. Trans thoracic echocardiogram suggested a left to right shunt (Qp/Qs 1.25) and a large retro aortic vascular structure draining into the right atrium. Computed tomography revealed a 22 mm calcified varicose aneurysmal vessel arising from the proximal circumflex artery, interposed between the left atrium and aortic root draining into the medial portion of the right atrium. Moderate enlargement of the RA was also seen. Coronary angiography confirmed the diagnosis. Case was discussed with the Heart team and surgical closure was recommended.
Results: Right mini thoracotomy was performed at the level of the 5
th intercostal space. Cardiopulmonary bypass was instituted femorally; both cavae were snared and the case was done on a beating heart through a right atriotomy. The opening of the fistula was located at the cavo-atrial junction and closed with two pledgeted sutures. Patient was weaned off cardiopulmonary bypass easily. Post op echo revealed resolution of the shunt. She was extubated shortly after surgery and discharged home on POD 11. Her hospital stay was prolonged due to EP evaluation for bradycardia. She was seen for follow up three weeks later with total resolution of her SOB and doing well.
Conclusion: Surgical closure of coronary cameral fistulae can be safely performed using minimally invasive techniques. To our knowledge this is the first case reported of a cameral fistula closed surgically using a minimally invasive approach.
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