Spontaneous Thrombotic Obstruction of Aneurysmal Coronary Arteriovenous Fistula

Excerpt

A 5-year-old boy was admitted to our hospital for cardiac catheterization. When he was 6 months old, echocardiography revealed a coronary artery fistula draining into the right ventricle (Fig. 1a). Because there were no ischemic symptoms, he was followed-up without medication. Echocardiography carried out before the cardiac catheterization revealed the absence of coronary fistula’s shunt into the bloodstream and a dilated right coronary artery orifice. Coronary angiography (Fig. 1b) revealed a mildly dilated right coronary artery with a moniliform aneurysm ~10 mm in diameter at the distal end. The end of the aneurysm was cecal and manifested poor washout of contrast medium. There was little arborization in the distal region of the right coronary artery adjacent to the aneurysm. Two months after the angiogram, computed tomography (CT) (Fig. 1c) was performed to clarify the positional relationship between the aneurysms and the heart. After the cardiac catheter evaluation, aspirin administration was initiated for fear of thrombus formation in the aneurysm.

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