Özet:

OBJECTIVE: The term coronary cameral fistula describes a sizeable communication between a coronary artery and a chamber of the heart that bypasses the myocardial capillary bed. In patients with mitral stenosis, coronary revascularization and fistula originating from the circumflex coronary branch is an indicator of left atrial thrombus. CASE: A 51-year-old male who was a former coal miner admitted to our hospital with complaints of shortness of breath and atypical chest pain. Transthoracic echocardiography revealed mitral stenosis and left atrial thrombus. Transesophageal echocardiography showed that the thrombus was spreading out from the left atrial appendix towards the interatrial septum and the base of atrium. Coronary angiogram revealed extensive network of vessels arising from the circumflex coronary artery draining into a solid lesion originating from left atrium. He was scheduled to undergo mitral valve surgery and surgical closure of the coronary cameral fistula. In the operation, giant thrombus extending from the base of atrium to the origin of the right pulmonary vein and down to the interatrial septum and mitral valve annulus was detected. Thrombus was carefully dissected and peeled off from the left atrial wall. Underneath the thrombus –situated at the center of the line between the superior pulmonary veins and atrial appendage– approximately 2-2,5 cm. distant from the posterior mitral annulus, ostium of the coronary cameral fistula was found. The ostium was closed by simple sutures and the mitral valve was replaced. CONCLUSION: Coronary cameral fistulas accompanying left atrial thrombus in cases of mitral stenosis may emerge in variable forms. Although the most common drainage site for these fistulas is atrial appendage, the other regions of left atrium should be carefully inspected for exactly localizing the ostium of the fistula.

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