PMC8241900_01
(A-C) depict the axial, coronal, and sagittal panel of the preoperative CTA, respectively. The white arrows indicated the fistula and RCAA. (D-F) depict the axial, coronal, and sagittal panel of the 6-months follow-up CTA, respectively. The white arrows indicate the mild dilated RCA. (G,H) show the preoperative and postoperative echocardiography images of the patient. A large fistula and RCCA to RV shunt was indicated by the arrow. RCA, right coronary artery; RCAA, right coronary artery aneurysm; LV, left ventricle; RV, right ventricle.
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F1
Transthoracic echocardiogram showed a large fistulous tunnel arising from the RCA, coursing anteriorly into a large aneurysm before entering the RV (Figure 1G). Computed tomography angiography demonstrated the dilated and tortuous tunnel arising from the right aortic sinus and traversing the epicardial surface before opening into the anterolateral aspect of the RV (Figures 1A-C, 2A,B). Postoperative echocardiography showed that the fistula was closed and the coronary artery aneurysm was reduced (Figure 1H). Six-month CTA showed that RCA was unobstructed without any thrombosis, and we just found a mild dilation of the initial part of RCA (Figures 1D-F).
(A,B) depicted the reconstructed image of the heart and dilated right coronary artery. (C-F) depicted the surgical repair process. RCA, right coronary artery; RCAA, right coronary artery aneurysm; AO, aorta.
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F2
Computed tomography angiography demonstrated the dilated and tortuous tunnel arising from the right aortic sinus and traversing the epicardial surface before opening into the anterolateral aspect of the RV (Figures 1A-C, 2A,B). A huge coronary artery aneurysm appeared on the epicardial surface (Figure 2C) The dilated RCA was cut open and a true intramyocardial tunnel covered with endocardium was revealed (Figure 2D). A discrete neck of the fistula opening into the enlarged RCA was identified and closed with a bovine pericardium patch, and the RCA wall was trimmed and reconstructed with a running suture (Figures 2E,F).