Left Circumflex Coronary Artery to Bronchial Arterial Fistula Associated with Tetralogy of Fallot: A Case Report and Review of Literature
Left Circumflex Coronary Artery to Bronchial Arterial Fistula Associated with Tetralogy of Fallot: A Case Report and Review of Literature
Zunping Ke1, Chao Li2, Qiang Liu3, Gang Bai4, Junfeng Wang5, Ming Zhou5 and Xiao Dong5,*
ABSTRACT
A 53-year-old man with tetralogy of Fallot and coronary artery to bronchial arterial fistula is reported. The communication of fistula arising from the proximal left circumflex coronary artery was discovered by routine coronary artery angiography before correction surgery. The patient then underwent TOF correction surgery. Considering the significance of the fistula, it better be found out and ligated prior to cardioplegic arrest in the surgery. Although extensive searching, the anomaly communication cannot be found. To avoid systemic hypoperfusion on bypass through loss of volume to the pulmonary circulation and shunting of cardioplegic solution to the pulmonary circulation through the fistula, a little increase of cardioplegic solution was given and the surgery was performed successfully. VSD was closed by using autologous pericardium patch, whilst pulmonary valvotomy, pulmonary arterioplasty and right ventricular outflow tract (RVOT) augmentation were performed using a patch of autologous pericardium. Tricuspid valve regurgitation was solved by contract tricuspid ring using an autopericardial ring. The patient recovered well after surgery and without any symptom in 12 months’ follow up. In this study, we reported a TOF patient with coronary artery to bronchial arterial fistula survived to undertake surgery until in a very old age. Though we could not find out the fistula during surgery, on account of the left-to right shunt caused by the fistula, further occlusion by transcatheter procedure was recommended for this patient.
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