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A Man in His 50s With Cardiac Tamponade From Ruptured Coronary Artery Aneurysm

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1 Credit CME

A man in his 50s was admitted to the hospital with acute chest pain and dyspnea. On examination, his systolic blood pressure was 82 mm Hg, and heart rate was 125 beats per minute. Coronary computed tomography angiography (Figure, A) and transesophageal echocardiogram (Video 1) revealed a tortuous coronary artery fistula (CAF) with a giant cauliflowerlike aneurysm originating from the dilated left main trunk and draining into the main pulmonary artery. Considering the presence of hemopericardium (Figure, A), spontaneous ruptured aneurysm secondary to CAF was suspected as the cause of cardiac tamponade. This diagnosis was confirmed by the findings of emergency surgery (Figure, B; Video 2). Surgical repair was successfully performed with aneurysm excision, fistula closure, and coronary artery bypass grafting (Video 3). The postoperative course was uneventful. Cardiac tamponade attributable to ruptured aneurysm of a CAF is exceptionally rare but life-threatening; such a condition requires prompt diagnosis and urgent surgery.1,2

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Article Information

Corresponding Author: Zhenghua Xiao, MD, Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guo Xue Alley No. 37, Sichuan, Chengdu 610041, China (xiaozhenghua@wchscu.cn).

Conflict of Interest Disclosures: None reported.

Funding/Support: This cardiology image article was supported by grant 81670327 from the National Natural Science Foundation of China; grants 2019YJ0046 and 2018SZ0384 from the Sichuan Science and Technology Program; grant 2018HXFH091 from the 1·3·5 Project for Disciplines of Excellence, West China Hospital, Sichuan University; and grant 2019HXFH027 from the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Al-Hijji  M , El Sabbagh  A , El Hajj  S ,  et al.  Coronary artery fistulas: indications, techniques, outcomes, and complications of transcatheter fistula closure.   JACC Cardiovasc Interv. 2021;14(13):1393-1406. doi:10.1016/j.jcin.2021.02.044PubMedGoogle ScholarCrossref
2.
Yun  G , Nam  TH , Chun  EJ .  Coronary artery fistulas: pathophysiology, imaging findings, and management.   Radiographics. 2018;38(3):688-703. doi:10.1148/rg.2018170158PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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