Congenital Right Coronary Artery to Right Ventricle Fistula Ligation Without Cardiopulmonary Bypass

An 11-month-old boy was hospitalized because of a complaint of mild dyspnea and continuous cardiac murmur. A chest x-ray revealed heart shade enlargement. Multidetector computed tomography and coronary angiography revealed that the right coronary artery (RCA) was dilated (6.37 mm maximum diameter) with a fistula directly connecting into the right ventricle from the end of the mid-RCA. Both coronary arteries arose from the correct side, with a hypoplastic left coronary system observed via the angiogram.

The authors decided to operate through a full median sternotomy approach in the absence of the establishment of cardiopulmonary bypass. Intraoperative findings revealed that the RCA was completely dilated with a fistula to the right ventricle. The fistula originated from the end of the mid-RCA and presented a significantly palpable systolic thrill. The authors exposed the fistula and tried to tighten it by a vascular tourniquet for 10 minutes. There were no signs of myocardial ischemia on intraoperative monitors. Then, the distal end of fistula was doubly ligated. During the postoperative period, the patient was hemodynamically stable with normal electrocardiography. Six-month follow-up showed no evidence of recurrent coronary fistula and normalized right ventricular size via echocardiography.