2021 Volume 70 Issue 3 Pages 577-582
We report a rare case of coronary arteriovenous fistula draining into the coronary sinus with giant coronary artery aneurysm. A 65-year-old woman was referred to our hospital with leg edema and shortness of breath, which are indicative of heart failure. Echocardiography showed enlargement of both ventricles and each atrium, moderate functional mitral regurgitation, normal ejection fraction, and pulmonary hypertension. From the parasternal aortic short-axis view, we noticed an enlargement of the left main trunk coronary artery. Color Doppler echocardiography revealed a huge spherical mass with a blood flow signal on the surface of the lateral wall. This huge mass spread with a beaded appearance on the posterior wall. In addition, an enlarged coronary sinus was detected from the parasternal long-axis view. A blood flow signal from the enlarged coronary sinus draining into the right atrium was detected in the entire cardiac cycle measured by continuous-wave Doppler echocardiography (flow velocity, 1.6 m/s). These findings suggested the presence of coronary arteriovenous fistula complicated by a giant coronary aneurysm. Cardiac CT (computed tomography) showed similar findings, and the diameter of the aneurysm was 50 mm. Resection of the aneurysm, coronary artery bypass grafting, and mitral valve repair were performed because the pulmonary-to-systemic blood flow ratio was 2.4 on cardiac catheterization and the diameter of the aneurysm was large, which was considered to be at high risk of rupture. We must pay attention to abnormal blood flow signals in the right heart cavity and pulmonary artery, bearing in mind the presence of coronary arteriovenous fistula, when coronary aneurysms are observed on echocardiography.
