3 ︱ DISCUSSION
Of all types of CAF, giant left coronary aneurysm with right atrium
fistula is uncommon 4. It has been reported that 90%
of CAF originated from the right coronary artery, of which only 0.2%
were giant coronary aneurysms (> 4 times of the normal
diameter) 5. CAF often has no specific clinical
manifestations, with or without angina pectoris and cardiac murmur,
which is closely affected by the location and size of the fistula. The
optimal treatment for CAF remains controversial, the most common
approaches are transcatheter closure of the fistula, surgical resection
of the aneurysm, and bypass grafting of the coronary artery. Multimodal
imaging and functional testing play vital roles in the diagnosis of CAF.
Specially, coronary angiography and cardiac CT are universal methods for
diagnosing and tracking the anatomical abnormalities of coronary.
However, coronary angiography is invasive, and CT often misses tiny
breaks. In this study, we proved that TTE and TEE are necessary and
sufficient to determine the complex anatomy of coronary fistula and its
relationship to adjacent structures, and can be used for preoperative,
intraoperative, and postoperative assessments. Echocardiography has the
advantages of non-invasive, real-time, and inexpensive, especially in
detection of the rupture and location of fistula by color Doppler. It is
worth noting that the echocardiographic images in this case need to be
differentiated from the three-atrial heart, and the apical four-chamber
view of TTE may easily mistake the aneurysm wall for the right atrial
septum and the fistula for the septal hole.