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The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 52-56, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Traumatic coronary artery-right heart fistula. Report of a case and review of the literature

LH Reyes, LK Mattox, WH Gaasch, R Espada and AC Beall Jr

Although the left coronary artery is the most frequently injured vessel of the heart, traumatic fistulas appear more often in the right coronary vessels, as the initial injury to the left coronary artery usually results in early death prior to hospitalization. Indications for surgical repair include cardiac decompensation and signs of shunt progression. In asymptomatic patients with no changes in cardiac function, consideration for repair includes the following: (1) enlargement of the fistula, causing a large runofff into the low- pressure chamber, and reduction of blood supply to the local myocardium distal to the fistula; (2) progressive dilatation of a pseudoaneurysm when it exists; and (3) the presence of bacterial endarteritis. Surgery usually has been indicated in reported cases of coronary artery fistula. Conservative management is applicable when the shunt is small and cardiac function is normal, as evidenced by the present case report and the first case cited in the literature. Oversewing of the area of the fistula and bypass grafting from the ascending aorta to the distal coronary tree might provide an additional mode of management in selected cases.


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 Ann. Thorac. Surg.Home page
C. H. Friesen, J. G. Howlett, and D. B. Ross
Traumatic coronary artery fistula management
Ann. Thorac. Surg., June 1, 2000; 69(6): 1973 - 1982.
[Abstract] [Full Text] [PDF]


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