European Journal of Echocardiography 2008 9(1):121-122; doi:10.1016/j.euje.2007.04.008
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.
Coronary artery to left ventricular fistula demonstrated by transthoracic echocardiography
Nurcan Arat*,
Ozgul Malcok Gurel,
Funda Senay Biyikoglu and
Erdal Duru
Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
Received 16 February 2007; accepted after revision 6 April 2007; online publish-ahead-of-print 9 July 2007.
* Corresponding author. 9.cadde 110.sokak, Vadi 3000 sitesi, No: 2 A/24, 06700, Birlik mahallesi, Ankara, Turkey. Tel: +90 505 502 5077; fax: +90 312 362 4502. E-mail address: aratnurcan{at}gmail.com
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Abstract
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Coronary artery fistulas are rare coronary anomalies which generally
require coronary angiography for definitive diagnosis. Improvements
in ultrasound technology has enabled direct, transthoracic visualization
of long portions of coronary arteries. We report a patient with
a symptomatic coronary to left ventricular fistula, which was
diagnosed with transthoracic echocardiography.
Keywords: Congenital; Coronary artery abnormality; Fistula; Transthoracic echocardiography
A 70-year-old female was hospitalized for coronary angiography with the complaint of chest pain and exercise dyspnoea. Physical examination revealed a first degree systolic murmur best heard at the left sternal border. ECG showed normal sinus rhythm with negative T waves in lead 2 and all precordial leads (Figure 1). Transthoracic echocardiography revealed normal left and right ventricular size and function without significant valvular disease. Colour Doppler showed multiple turbulent jet areas originating from the distal LAD and draining into the left ventricle (Figure 2, Movies 1–3). Coronary angiography demonstrated a large fistula with multiple openings originating from the distal left anterior descending coronary artery (LAD) with no significant coronary artery stenosis (Movie 4). Although coronary angiography is the gold standard,1 other techniques are frequently used to delineate the anatomy including transoesophageal echocardiography, three-dimensional echo imaging, magnetic resonance imaging,2 and multidetector computed tomography.3 Coronary artery fistulas (CAFs) are thought to be an embryologic persistence of primitive intratrabecular spaces which allow the developing coronary artery to communicate with the other cardiac chambers or vascular structures.4 CAFs are present in 0.05%–0.25% of patients undergoing coronary angiography.4–6 Accurate evaluation is often difficult. However, improvements in ultrasound technology has enabled direct, transthoracic visualization of long portions of coronary arteries and can be a useful adjunct to other methods of coronary artery examination.
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Supplementary material
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Supplementary data associated with this article can be found in the online version.
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References
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