Korean Circ J.  2014 May;44(3):196-199. 10.4070/kcj.2014.44.3.196.

An Adult Case of Tetralogy of Fallot Accompanied by Multiple Anomalies Including Multidirectional Coronary Artery Fistulas

• Lee JJ
• Cho JY
• Lee YH
• Lee BH
• Park CG
• Seo HS
• Oh DJ
• Na JO

• KMID: 2145483
• DOI: http://doi.org/10.4070/kcj.2014.44.3.196

Abstract

Multidirectional coronary artery fistulas (CAFs) are rare in patients with tetralogy of Fallot (TOF). We report an adult patient who underwent open-heart surgery for TOF 24 years before the discussed presentation. Coronary angiogram and cardiac computed tomography revealed multidirectional CAFs originating from the left main coronary artery and draining to the left atrium, pulmonary artery and subphrenic artery. The patient also showed additional congenital anomalies, such as persistent left superior vena cava and right-sided aortic arch.

Keyword

Tetralogy of Fallot; Arteriovenous fistula; Coronary artery

MeSH Terms

Adult*
Aorta, Thoracic
Arteries
Arteriovenous Fistula
Coronary Vessels*
Fistula*
Heart Atria
Humans
Pulmonary Artery
Tetralogy of Fallot*
Vena Cava, Superior

Figure

• 

  Fig. 1 Echocardiography images. A: dilated coronary sinus was seen, and there was no remnant shunt flow through the perimembranous portion. B: modified two-chamber view showing definite dilation of the coronary sinus suggesting PLSVC. LV: left ventricle, LA: left atrium, CS: coronary sinus, Ao: aorta, PLSVC: persistent left superior vena cava.

• 

  Fig. 2 Images of cardiac computed tomography. A: arrows indicate the coronary artery fistula, which arises from the proximal portion of the left main coronary artery and drains into the left atrium. B: an axial image showing the right-sided Ao and the presence of PLSVC. Ao: aorta, PLSVC: persistent left superior vena cava.

• 

  Fig. 3 Coronary angiography images. A: coronary artery fistula originating from the proximal portion of the left main coronary artery and draining to the left atrium (arrow). B: the descending branch of the fistula communicating with the subphrenic artery (arrow), and the lateral branch communicating with the pulmonary artery (arrowheads).

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