Transesophageal echocardiography, more than a diagnostic tool: use during surgical ligation of coronary artery fistulae - a case report

Chung, Ping-Chen; Huang, P J; Liu, Yufang; Chen, Kuen‐Bao

doi:10.1186/1749-8090-7-28

Cited by 4 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most obvious of these is in the form of a dilated proximal culprit coronary artery; with close relation to the transesophageal echocardiography (TEE) probe, the proximal origins of the coronary arteries are exquisitely delineated by this modality. 6 Occasionally the actual fistulous tract is imaged, 7 more often however, the distal cameral end is alone visualized on color Doppler interrogation as in our case which demonstrates diastolic blood flow into the chamber. Importantly chamber dilation is unusual in this kind of shunt lesion.…”

Section: Discussionmentioning

confidence: 70%

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

Shivaprasad¹,

Subash²,

Jayant³

2013

Journal of Perioperative Echocardiography

View full text Add to dashboard Cite

Coronary artery fistulae (CAF) are rare anomalies. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the diagnosis and management of CAF. A 3-year-old child diagnosed to have ostium secundum atrial septal defect (OS ASD) was posted for surgical closure under cardiopulmonary bypass (CPB). Post procedure TEE revealed a single continuous turbulent jet toward right atrium near the lateral wall of tricuspid region and was diagnosed as CAF communicating right coronary artery and right atrium. Surgical ligation of the CAF under CPB was done and the child was discharged postoperatively without complications. This case highlights the utility of intraoperative TEE in the diagnosis and management of CAF. How to cite this article Subash S, Shivaprasad BM, Jayant A, Puri GD. Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography. J Perioper Echocardiogr 2013;1(1):27-29.

show abstract

Section: Discussionmentioning

confidence: 70%

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

Shivaprasad¹,

Subash²,

Jayant³

2013

Journal of Perioperative Echocardiography

View full text Add to dashboard Cite

show abstract

“…[1][2][3] However, the limitations of 2D TEE make angiography the preferred method of visualizing this pathology. [1][2][3] However, the limitations of 2D TEE make angiography the preferred method of visualizing this pathology.…”

Section: Echo Roundsmentioning

confidence: 99%

Imaging of Coronary Artery Fistulae by Using Intraoperative Three-Dimensional Transesophageal Echocardiography

Kim

Seok

et al. 2014

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

A 51-year-old woman underwent off-pump coronary artery bypass surgery. Preoperative coronary angiography showed 70% segmental stenosis in the midpart of the left anterior descending coronary artery (LAD) and multiple fistula tracks from the proximal LAD and the proximal right coronary artery (RCA) to main pulmonary artery (MPA) (Fig. 1).Pairs of orthogonal 2-dimensional (2D) midesophageal aortic valve images with color-flow Doppler (CFD) in "X-plane mode" that focused on the proximal RCA and LAD were taken by using intraoperative transesophageal echocardiography (TEE) (iE33™ and X7-2t™; Philips Healthcare, Bothell, WA) (Fig. 2, A and B; see Video 1, Supplemental Digital Content 1, http://links.lww.com/ AA/A713): the proximal LAD flow and multidirectional turbulent color jet branches suggesting known LAD fistulae flows were partly delineated, but the RCA flow and its fistula flow were not visualized. Spectral velocity tracing of pulsed-wave Doppler by placing the sample volume at the proximal LAD showed abnormal flow patterns comprising notched systolic antegrade flow and diastolic reversal flow, which presumably indicates the complexity of the flow pattern (Fig. 2C). However, sample volume might indicate mixing of the LAD and adjacent fistula flows, since the fixed sampling site could not consistently trace the LAD flow during the entire cardiac cycle.Electrocardiographically gated acquisition of 3D full-volume images with CFD was performed with brief cessation of mechanical ventilation. The regions of interest (ROI) of the echocardiographic image and color-Doppler box were placed on the assumed proximal LAD and RCA in 2D midesophageal aortic valve X-plane images. Seven narrow-volume datasets were rendered over 7 consecutive heartbeats and automatically integrated to produce a single 3D full-volume image with CFD data ( Fig. 3; see Video 2, Supplemental Digital Content 2, http://links.lww.com/ AA/A714 and see Video 3, Supplemental Digital Content 3, http://links.lww.com/AA/A715): echocardiographic gain, compression, and smoothing were adjusted to 15%, 25% to 35%, and 5/9, respectively. Next, 3D echo bright (black/ white, B/W) anatomic datasets were selectively removed by activating B/W suppression in on-cart after processing. Finally, only 3D CFD datasets remained in the display with the scale of 112.4 cm/s and depicted a multidirectional flow pattern (Fig. 3). For better delineation of the fistulae flows and their differentiation from coronary arterial flows, CFD gain, smoothing, and filter were adjusted to 40 to 50/100, 5/9, and 4 to 5/9, respectively. Back-and-forth toggling "B/W suppression" of the 3D CFD images with further fine rotation facilitated a more detailed understanding of their spatial relationships between the fistulae and adjacent cardiac structures. The overall extent and shape of the fistulae delineated in these 3D images corresponded well to the preoperative angiographic findings: a single fistula arose from the proximal RCA and drained into the anterior aspect of the MPA, and a fistula networ...

show abstract

Ruptured Giant Coronary Artery Aneurysm With Coronary Artery to Pulmonary Artery Fistula Presenting as Cardiac Tamponade Diagnosed by Intraoperative Transesophageal Echocardiography: A Case Report

Chiricolo¹,

Pantin²,

Raffel³

et al. 2018

A&A Practice

View full text Add to dashboard Cite

A 63-year-old woman presented with cardiac tamponade because of a ruptured giant left anterior descending coronary artery aneurysm with a fistula to the main pulmonary artery. The diagnosis was made intraoperatively during an emergent subxiphoid pericardial window using transesophageal echocardiography and confirmed by intraoperative coronary angiography. Because of this prompt diagnosis, the patient was successfully managed with immediate surgical repair of the aneurysm and fistula.

show abstract

Transesophageal echocardiography, more than a diagnostic tool: use during surgical ligation of coronary artery fistulae - a case report

Cited by 4 publications

References 17 publications

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

Imaging of Coronary Artery Fistulae by Using Intraoperative Three-Dimensional Transesophageal Echocardiography

Ruptured Giant Coronary Artery Aneurysm With Coronary Artery to Pulmonary Artery Fistula Presenting as Cardiac Tamponade Diagnosed by Intraoperative Transesophageal Echocardiography: A Case Report

Contact Info

Product

Resources

About