case_images: PMC6180877_01
case_images: Pre-operative view (a-e). (a) Echocardiography showed a fistula in the parasternal long axis view. (b) DSCT with VR of the fistula, posterior view. (c) VR of coronary artery tree clearly demonstrating a connection between LMCA and SVC. (d) DSCT MIP, coronal view. (e) MIP, axial view. (f) Post-operative short-axis view of dilated LMCA (arrow indicates the closure of the fistula). Arrows in (a-e) indicate the fistula. AO, aorta; DSCT, dual-source CT; LA, left atrium; LMCA, left main coronary artery; MIP, maximum intensity projection; SVC, superior vena cava; VR, volume rendering.
case_images: bjrcr.20150387.g001.jpg
case_images: PMC6180877_01_bjrcr.20150387.g001.jpg
case_images: fig1
case_images: No apparent abnormality was seen at the origin and along the route of the left anterior descending, left circumflex and RCA (Figure 1b-e). During the operation, a fremitus of SVC could be felt and the fistula's ostium in the SVC, approximately 4 mm, was sutured. 7 days later, an echocardiography was re-examined and showed no abnormal blood flow between the LMCA and the SVC (Figure 1f).