An Unusual Transesophageal Echocardiographic Finding After Surgical Correction of a Coronary Artery Fistula

摘要

A 33-year-old man with a congenital right coronary artery (RCA)-left ventricle (LV) fistula was admitted because of gradually increasing heart failure. A preoperative angiogram revealed a right coronary aneurysm and LV volume overload caused by an RCA-LV shunt. The patient was scheduled for surgical closure of the fistula and reconstruction of the RCA.With cardiopulmonary bypass (CPB), the large right coronary aneurysm was dissected longitudinally. A composite graft of radial artery and saphenous vein was sequentially anastomosed to 10 orifices of RCA branches in the dissected RCA. The fistula, which was 8 mm in diameter, was directly closed at the orifice. Transesophageal echocardiography (TEE) showed an enlarged right coronary cusp, and its repair with an autograft of cardiac membrane completed the operation. The postoperative course was complicated by hemorrhage, and after 3 hours in the intensive careunit the patient was returned to the operating room for surgical hemostasis. During the hemostasis operation, TEE showed a fluttering stringlike echogenic lesion about 1 inch long in the Valsalva sinus. What is the diagnosis?