PMC8430395_01
Computed tomography angiography preoperatively showing that there is an interruption between right sinus of Valsalva and the enlarged and tortuous right main coronary artery (A, arrow), a single left coronary ostium with a giant coronary trunk (B, arrow), a 7-mm fistula into the right ventricle (Red) (C, arrow), the left and right coronary artery were connected with each other and formed a closed loop at the base of the heart (D).
fcvm-08-699529-g0001.jpg
PMC8430395_01_fcvm-08-699529-g0001.jpg
F1
There is an interruption between right sinus of Valsalva and the right main coronary artery (Figure 1A, arrow), single left coronary ostium with a giant coronary trunk (Figure 1B, arrow). A branch from the proximal end of right coronary artreatery was inserted into the right ventricle through a 7-mm fistula (Figure 1C, arrow). The right main coronary artery was connected with the left conus branch via the collateral branch while the left circumflex was communicated with the right coronary artery thus forming a closed loop at the base of the heart (Figure 1D).
Ascending aortic angiography preoperatively showing that the left and right coronary artery were enlarged and tortuous (A), right coronary artery was detected secondly to the left one (B), confirming the diagnosis of coronary artery ring with single left coronary ostium and fistula.
fcvm-08-699529-g0002.jpg
PMC8430395_01_fcvm-08-699529-g0002.jpg
F2
Ascending aortic angiography was performed and further confirmed this malformation (Figure 2, Supplementary Video 2).
Intraoperative view showing that the fistula was ligated with off-pump strategy.
fcvm-08-699529-g0003.jpg
PMC8430395_01_fcvm-08-699529-g0003.jpg
F3
Because of extreme vessel tortuosity and inability to deliver a catheter far enough distally, the coronary fistula was then surgically ligated with off-pump strategy (Figure 3).
Transthoracic echocardiography showing that a 6.28-mm coronary fistula into the right ventricle (A, arrow) was detected preoperatively, and undetectable 1 week post-surgical ligation (B).
fcvm-08-699529-g0004.jpg
PMC8430395_01_fcvm-08-699529-g0004.jpg
F4
The patient discharged on postoperative day 5 and free of symptoms during the 3 years of follow-up (Figure 4).