Multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula

The purpose of this study was to examine the advantages of multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula, specifically in depicting the origin, the course, and the drainage site. Seven consecutive patients ranging in age from 20 to 72 years with a suspected coronary artery fistula underwent conventional transthoracic and multiplane transesophageal echocardiographic studies between March 1993 and July 1994. When a coronary artery fistula was noted, the origin, the course, and the drainage site were carefully searched for. All patients then underwent a cardiac catheterization with the performance of coronary angiography. A large right coronary artery fistula was detected in three patients; one of them had a drainage to the posterior left ventricle, one to the lateral right ventricle, and the other to the medial aspect of the right ventricle just below the insertion of the septal leaflet of the tricuspid valve. A small coronary artery fistula arising from the left coronary artery was noted in four patients, two from the left anterior descending artery and the other two from the left circumflex artery. Three of these four patients had a drainage to the main pulmonary artery and one to the left ventricle. The drainage site was clearly depicted in all seven patients, whereas the origin and the course were precisely defined in five patients by using multiplane transesophageal echocardiographic examination. The multiplane transesophageal echocardiography provides a panoramic view of the coronary artery and the fistulous vessel with a precise definition of the origin, the course, and the drainage site of the fistula. Therefore it is the noninvasive diagnostic mode of choice.