伊賀 幹二¹, 泉 知里¹, 高橋 秀一², 小西 孝¹

Kanji IGA¹, Chisato IZUMI¹, Shuichi TAKAHASHI², Takashi KONISHI¹

¹天理よろず相談所病院循環器内科, ²天理よろず相談所病院臨床病理部

¹Department of Cardiology, Tenri Hospital, ²Department of Clinical Pathology, Tenri Hospital

キーワード : Coronary artery fistula , Transthoracic echocardiography , Transesophageal echocardiography

We analyzed seven cases of angiographically proved coronary artery fistula retrospectively to study the usefulness and limitations of transthoracic and transesophageal echocardiography. Anomalies included coronary to right ventricular fistula, three cases; coronary to left ventricle, one case; coronary to pulmonary artery, one case; and anomalous origin of the left coronary artery from the pulmonary pulmonaly artery (ALCAPA), two cases. Proximal coronary arteries were normal in size in one case of pulmonary fistula, although one aneurysm of the coronary artery and one anomalous vessel were present. Initial transthoracic echocardiography led to a diagnosis in only three cases. After minute examination, however, an abnormal channel was identified adjacent to the Valsalva sinus in five cases and was proved to be a dilated coronary artery in four of them. A color flow signal was seen in the septal branch of the left anterior descending artery in one case of ALCAPA. Transesophageal echocardiography showed dilatation of a proximal coronary artery connecting to an enlarged vessel located in the atrioventricular groove. Maximal velocity across the orifice was measured in three cases. ALCAPA was diagnosed by transesophageal echocardiography because the enlarged left coronary artery disconnected to the left coronary cusp, although the enlarged right coronary artery originated from the right coronary cusp. In two cases, the large number of collateral vessels made it difficult to visualize the orifice of the fistula in the angiograms; however, transesophageal echocardiography showed the anatomy of the orifice morphology in more detail. Screening for coronary artery fistula is difficult by transthoracic echocardiography; when used in conjunction with transesophageal echocarjdiography, however, transthoracic echocardiography provides synergistic information after an angiography-based diagnosis has been made.