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European Journal of Echocardiography Advance Access originally published online on April 27, 2008
European Journal of Echocardiography 2008 9(5):712-715; doi:10.1093/ejechocard/jen140
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient

Sérgio Nabais1,2,*, Nuno Salomé1, Aida Brandão1, Alda Simões1, Jorge Marques1, João Costa1, Luís Basto1, António Costeira1 and Adelino Correia1

1 Cardiology Department, Hospital de S. Marcos, Apartado 2242, 4701-965 Braga, Portugal
2 Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal

Received 28 September 2007; accepted after revision 21 March 2008; online publish-ahead-of-print 27 April 2008.

* Corresponding author. Tel: +351 933 406 200/+351 253 209 155; fax: +351 253 209 091. E-mail address: sergionnabais{at}gmail.com


  Abstract

Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stress-induced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.

Keywords: Coronary artery fistulae; Cor triatriatum; Congenital heart disease; Three-dimensional echocardiography; Angina; Coronary artery disease


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