Left circumflex coronary artery-to-left atrium fistulas detected by transesophageal echocardiography in heart transplant recipients.

Coronary fistulas are uncommon after heart transplantation. We report two cases of fistulas from an atrial branch of the circumflex coronary artery to the left atrium after heart transplantation. This has not been previously reported in the literature. They were detected with transesophageal echocardiography, and images are shown for the first time. Transesophageal echocardiography may be useful in the follow-up of heart transplant recipients. (EC'HOCARDIOGRAPfl, Volume 17, July 2000) coronary fistula, left atrium, circumflex coronary artery, transesophageal echocardiography The reported angiographic incidence of coronary fistulas after heart transplantation is 5.414%.132 Echocardiography has a complementary role in its diagnosis, with no echocardiography series available on heart transplant recipients. Nevertheless, in some cases,3 it has proved to be similar to angiography for this purpose. Coronary fistulas in the transplanted population are congenital or iatrogenic. The latter occurs after the implantation surgery or after endomyocardial biopsy. Although different fistula localizations have been reported, a fistula from an atrial branch of the circumflex coronary artery to the left atrium after surgery has never been reported in the literature. We describe two cases of such an occurrence that were detected with transesophageal echocardiography (TEE).