Background A coronary cameral fistula is a rare connection between a coronary artery and a cardiac chamber or vein bypassing the cardiac capillary bed system. Most of these fistulae are congenital and solitary, although they can be acquired and multiple. Cases presentation Case 1: A 10-year-old black South African boy presented with a long-standing history of fatigue; he had a heart murmur, and a bounding pulse and wide pulse pressure. An echocardiogram demonstrated a large coronary cameral fistula involving his left coronary artery and his left ventricle. This was also confirmed on ascending aortogram. Surgical ligation was done and his symptoms improved afterward, but a small residual fistula remained. Case 2: A 7-year-old black South African boy had decreased effort tolerance and a heart murmur on the mid-sternal border. He had cardiomegaly on chest roentgenogram and a dilated left coronary artery origin on echocardiogram. An ascending aortogram confirmed a large left coronary cameral fistula draining to the left ventricle. Case 3: A 28-year-old black South African woman with decreased effort tolerance and chest pain on exertion had a continuous murmur over the lower sternal border. Echocardiography demonstrated a dilated right coronary artery with a fistulous connection to her right ventricle. An ascending aortogram demonstrated a tortuous coronary cameral fistula arising from her right coronary artery to her right ventricle. All three patients were successfully treated percutaneously using the Amplatzer vascular plug type II device. Conclusion The availability of numerous vascular closure devices has made transcatheter occlusion the treatment of choice for the majority of coronary cameral fistulae, rather than the traditional surgical ligation.

A 2.4-kg neonate presented with a right-sided aortic arch with a retroesophageal aortic segment; chromosome 22q11 deletion was positive. Computed tomography (CT) angiography with three-dimensional (3D) reconstruction ( Fig. 1(a) and (b)) proved superior to echocardiography for diagnosis. Total repair ( Fig. 2(a) and (b)) was similar to that for type B interrupted aortic arch. www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 39 (2011) e29 [ ( ) T D $ F I G ]Fig. 1. (a) Antero-superior view and (b) postero-superior view. CT angiography with 3D reconstruction showing a right aortic arch giving origin to the RCA, the LCA and the RSA. From the RSA, a relatively small but patent aortic segment (REAS) passed leftward and posterior to both the trachea and esophagus to join the proximal descending aorta from which the LSA arose. On the left side of the trachea, the large PDA connects to the DA. DA: descending aorta, LPA: left pulmonary artery, LSA: left subclavian artery, MPA: main pulmonary artery, PDA: patent ductus arteriosus, RCA: right carotid artery, REAS; retroesophageal aortic segment, RSA: right subclavian artery. [ ( ) T D $ F I G ]Fig. 2. Surgical exposure by left thoracotomy; the PDA and LSA are shown in part (a), the REAS is shown in part (b). The REAS was divided using this approach. Total repair (as for type B interrupted aortic arch) was completed via sternotomy and use of deep hypothermic circulatory arrest. Postoperatively, the child developed an acute pulmonary hypertensive crisis 6 h after the repair; aggressive resuscitation (including ECMO support) was not successful. The child demised on the 2nd post-operative day shortly after the ECMO was terminated due to complications. Desc.: descending, PDA: patent ductus arteriosus, LSA: left subclavian artery, REAS: retroesophageal aortic segment.

The development of a pseudoaneurysm is a rare complication following repair of a coarctation of the aorta. Surgical management of pseudoaneurysms is associated with high morbidity and mortality. We describe the successful endovascular deployment of a covered stent in a sick infant with a descending aorta pseudoaneurysm, following the repair of an aortic coarctation. We highlight the challenges we encountered. Endovascular repair is a safe palliative alternative to re-do open surgery in unstable infants with large pseudoaneurysms following aortic coarctation repair. The role of endovascular stents as the final definitive therapy will remain limited by the deployable, small-size stents in small, growing children.(Heart, Lung and Circulation 2010;xxx:1-4)

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