Surgical treatment of left main and left anterior descending artery ectasia with fistula to right ventricle

Figures

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  Ectasia of LM and LAD coronaries with fistula to RV.

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  Figure 1. Coronary angiogram of a patient with LAD artery fistula to the RV that is associated with diffuse ectasia of the LM and LAD coronary arteries. A, Right anterior oblique caudal view showing the ectatic LM coronary and proximal LAD with a normal left CX artery. B, Right anterior oblique cranial view showing the LAD ectasia. LAD, Left anterior descending; LM, left main; CX, circumflex.

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  Figure 2. Computed tomography of the chest with contrast 2 years after the ligation of the LAD artery to RV fistula outflow. A, Axial view showing the ectatic LM coronary artery and the proximal and mid-LAD with no increase in its size. B, Reconstructed sagittal view showing the aortic root and the course of the ectatic LM and LAD in the interventricular groove. C, Rotated foreshortened sagittal view showing the area of closed LAD-RV fistula. LAD, Left anterior descending; LM, left main.

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  Video 1. Dr Turki Albacker explaining the important aspects of the case and the rationale for not excluding the ectatic artery surgically and not closing the entry point of the left anterior descending–right ventricle fistula. Video available at: https://www.jtcvs.org/article/S2666-2507(20)30139-5/fulltext.