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European Journal of Echocardiography Advance Access originally published online on May 4, 2009
European Journal of Echocardiography 2009 10(5):718-720; doi:10.1093/ejechocard/jep049
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

A case of coronary cameral fistula

Gareth J. Padfield*

Department of Cardiology, Edinburgh Royal Infirmary, Edinburgh, UK

Received 10 February 2009; accepted after revision 10 April 2009; online publish-ahead-of-print 4 May 2009.

* Corresponding author: Centre for Cardiovascular Science, The University of Edinburgh, Chancellor's Building, Edinburgh EH16 4SU, UK. Tel: +44 131 242 9475; fax: +44 131 242 6379. E-mail address: gareth.padfield{at}ed.ac.uk


  Abstract

An 85-year-old woman underwent transthoracic echocardiography for the investigation of breathlessness and atypical chest discomfort. Clinical examination was unremarkable. A standard 12 lead ECG demonstrated anterior T wave inversion, but was otherwise normal. Transthoracic echocardiography demonstrated a normally functioning left ventricle with hypertrophy and trabeculation of the apical and lateral segments. Imaging with colour flow Doppler demonstrated blood flow from the epicardial surface into the left ventricular cavity through the hypertrophied segment of myocardium during diastole. A diagnosis of multiple, diffuse coronary-left ventricular fistulae predominantly of a large diagonal branch of the left anterior descending artery was made at coronary angiography. The patient responded well to oral beta-blockade, reporting an improvement in symptoms 2 months later in the outpatient clinic. The echocardiographic appearances of coronary fistulae may cause diagnostic confusion, particularly in the presence of myocardial hypertrophy and trabeculation.

Keywords: Coronary fistula; Congenital abnormality


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