A rare case of giant left circumflex coronary artery fistula to coronary sinus in patient with persistent left superior vena cava and bicuspid aortic valve

Rami M Abazid; Aashish Goela; Ali Islam; Sarah Blissett

doi:10.1111/echo.15309

A rare case of giant left circumflex coronary artery fistula to coronary sinus in patient with persistent left superior vena cava and bicuspid aortic valve

Echocardiography. 2022 Mar;39(3):538-542. doi: 10.1111/echo.15309. Epub 2022 Feb 3.

Authors

Rami M Abazid¹, Aashish Goela², Ali Islam², Sarah Blissett¹

Affiliations

¹ Division of Cardiology, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
² Department of Radiology, London Health Sciences Centre, University Hospital, London, Ontario, Canada.

PMID: 35118713
DOI: 10.1111/echo.15309

Abstract

A 61-year-old male presented with symptoms of decompensated heart failure and cardiogenic shock. Transthoracic and transesophageal echocardiography showed severely impaired left ventricular (LV) systolic function (LVEF of 20-25%), bicuspid aortic valve with moderate aortic insufficiency and no significant stenosis, dilated coronary sinus and a tortuous vascular structure in the left-sided atrioventricular groove. Cardiac computed tomography confirmed the diagnosis of persistent left superior vena cava and a giant coronary artery fistula to the coronary sinus. Cardiac magnetic resonance illustrated non-specific late gadolinium enhancement in the mid-wall of the septum. The patient was treated medically and with cardiac re-synchronization therapy.

Keywords: coronary artery fistula; coronary sinus; persistent left superior vena cava.

Publication types

Case Reports

MeSH terms

Bicuspid Aortic Valve Disease*
Contrast Media
Coronary Sinus* / diagnostic imaging
Coronary Vessels / diagnostic imaging
Fistula*
Gadolinium
Humans
Male
Middle Aged
Persistent Left Superior Vena Cava*
Vena Cava, Superior / diagnostic imaging

Substances

Contrast Media
Gadolinium