1. Management of right coronary artery fistula caused by nail gun trauma
Akshay Bagai, MD, MHS, Jonathan Lu, MD, Bander Al-Amro, MD, Joao Rezende-Neto, MD, PhD, Vikramaditya Prabhudesai, MBBS, MS, Alun D. Ackery, MD, MSc, Bobby Yanagawa, MD, PhD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 152, Issue 6, Pages e139-e141 (December 2016)
DOI: /j.jtcvs
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
A lateral chest radiograph showing the nail penetrating the thorax (A). Computed tomography demonstrates the position relative to the nail to right ventricular outflow tract (RVOT), right atrium (RA), and right coronary artery (arrow; B and C). Ao, Aorta.
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
After surgical removal of the nail and repair of the right ventricular, a right coronaty artery-right ventricular outflow tract (RVOT) fistula (arrow) is shown by color flow Doppler on transesophageal echocardiography (A). A pseudoaneurysm of the right coronary artery (arrows) with fistula into the right atrium (RA) and RVOT is also demonstrated by computed tomography (B and C). Angiographically, a lobulated pseudoaneurysm (arrows) is seen in the proximal right coronary with contrast extravasation in the right-sided chambers (D) and successful deployment of a covered stent (E). LA, Left atrium; Ao, aorta; LV, left ventricle.
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4. A large nail penetrating the thorax, the right ventricular outflow tract, and the right atrium.
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5. Video 1
Right coronaty artery-right ventricular outflow tract and right atrium fistula is shown by color flow Doppler on transesophageal echocardiography. Video available at:
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6. Video 2
Aortic angiogram demonstrating a large pseudoaneurysm in the proximal right coronaty artery with contrast extravasation into right-sided cardiac chambers. Video available at:
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7. Video 3
A selective right coronaty artery (RCA) angiogram after deployment of the Papyrus-covered stent (BIOTRONIK) in the proximal RCA demonstrating cessation of fistulous flow. Video available at:
The Journal of Thoracic and Cardiovascular Surgery  , e139-e141DOI: ( /j.jtcvs )
Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions