Giant and aneurysmal left circumflex coronary fistula to coronary sinus—Cardiovascular computed tomography imaging before and after surgical operation

Summary An asymptomatic 43-year-old woman visited our hospital for differential diagnosis of cardiac murmur. The transthoracic echocardiogram exhibited a dilated duct, which had turbulently accelerated color Doppler flow behind left ventricle. The coronary angiography (CAG) revealed a marked dilated left circumflex artery (LCX), which appeared to connect to coronary sinus (CS), indicating coronary artery fistula. However, it was difficult to define the drainage site of fistula in CAG, because the imaging contrast was insufficient for markedly dilated LCX. The drainage site of fistula to CS was finally defined by electrocardiogram-gated 64-multi-detector computed tomography (MDCT), and MDCT revealed the LCX aneurysm in the termination site of fistula. The patient underwent ligation of LCX-CS fistula and direct closure of coronary aneurysm. After the operation, no residual coronary fistula flow was detected either by CAG or MDCT. We present here a patient with coronary aneurysm associated with coronary fistula (CAACF), who underwent surgical operation, and suggest that MDCT is a helpful modality for the diagnosis of CAACF.