Journal of Perioperative Echocardiography

Register      Login

VOLUME 9 , ISSUE 1 ( January-June, 2021 ) > List of Articles


Transesophageal Echocardiographic Imaging of Left Circumflex Artery to Superior Vena Cava Communication: Characterizing the Coronary Arteriovenous Fistula

Neeti Makhija, Devishree Das, Arindam Choudhury, KG Krithika

Keywords : Coronary arteriovenous fistula, Echocardiography, Left circumflex artery, Superior vena cava, Transesophageal echocardiography

Citation Information : Makhija N, Das D, Choudhury A, Krithika K. Transesophageal Echocardiographic Imaging of Left Circumflex Artery to Superior Vena Cava Communication: Characterizing the Coronary Arteriovenous Fistula. J Perioper Echocardiogr 2021; 9 (1):13-15.

DOI: 10.5005/jp-journals-10034-1121

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2021; The Author(s).


Coronary arteriovenous fistula (CAVF) is a rare form of congenital heart disease. Among the CAVFs, the right coronary artery (RCA) fistula is common. The majority of patients remain asymptomatic, and CAVFs are detected incidentally. Coronary angiography remains the primary diagnostic and therapeutic modality in the assessment of the fistula. In the perioperative setting, transesophageal echocardiography (TEE) is the modality of choice, which has been rarely reported to date. It not only confirms the fistulous tract but also confirms the other associated anomalies, biventricular function, and the adequacy of surgical repair. We report a TEE imaging of CAVF between the left circumflex artery (LCx) and right-sided superior vena cava (SVC).

PDF Share
  1. Khulbey SK, Agarwal S, Dikshit V. Coronary arteriovenous fistula between left circumflex artery and superior vena cava. Interact Cardiovasc Thorac Surg 2015;21(3):399–400. DOI: 10.1093/icvts/ivv126
  2. Gowda RM, Vasavada BC, Khan IA. Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 2006;107(1):7–10. DOI: 10.1016/j.ijcard.2005.01.067
  3. Lin FC, Chang HJ, Chern MS, et al. Multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula. Am Heart J 1995;130(6):1236–1244. DOI: 10.1016/0002-8703(95)90148-5
  4. Latson LA. Coronary artery fistulas: how to manage them. Catheter Cardiovasc Interv 2007;70(1):110–116. DOI: 10.1002/ccd.21125
  5. Ata Y, Turk T, Bicer M, et al. Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg 2009;4(1):62. DOI: 10.1186/1749-8090-4-62
  6. Shiga Y, Tsuchiya Y, Yahiro E, et al. Left main coronary trunk connecting into right atrium with an aneurysmal coronary artery fistula. Int J Cardiol 2008;123(2):e28–e30. DOI: 10.1016/j.ijcard.2006.11.108
  7. Angelini P. Coronary artery anomalies—current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J 2002;29(4):271–278. DOI: 10.1161/CIRCULATIONAHA.106.618082
  8. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 2008;118(23):2395–2451. DOI: 10.1161/CIRCULATIONAHA.108.190811
  9. Youn HJ, Foster E. Transesophageal echocardiography (TEE) in the evaluation of the coronary arteries. Cardiol Clin 2000;18(4):833–848. DOI: 10.1016/s0733-8651(05)70183-1
  10. Marcus B, Sivazlian K, Gordon LS. Echocardiographic detection of left circumflex coronary artery to left superior vena cava fistula by use of Doppler color flow mapping. J Am Soc Echocardiogr 1991;4(4):405–407. DOI: 10.1016/s0894-7317(14)80452-5
  11. Gensini GG, Palacio A, Buonanno C. Fistula from circumflex coronary artery to superior vena cava. Circulation 1966;33(2):297–301. DOI: 10.1161/01.cir.33.2.297
  12. Sharma VK, Kaul U, Shrivastava S. Left circumflex to right atrial coronary arterio-venous fistula—role of multimodality imaging for diagnosis. Indian Heart J 2014;66(2):231–234. DOI: 10.1016/j.ihj.2013.12.005
  13. Sawai T, Nakahira J, Minami T. Usefulness of intraoperative transesophageal echocardiography for evaluation of circumflex coronary artery fistula with ruptured aneurysm draining into coronary sinus. J Anesth 2015;29(6):962–966. DOI: 10.1007/s00540-015-2051-7
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.