Innovative method to diagnose Coronary Cameral fistula by Contrast
Echocardiography
Abstract
Introduction: Coronary artery fistula (CAF) is a rare cardiac anomaly
that typically presents as a continuous murmur in an otherwise
asymptomatic patient. Occasionally, it can result in congestive heart
failure or bacterial endocarditis. Objective: To better delineate the
course of coronary artery fistula for the first time, using the SonoVue
contrast agent during transthoracic echocardiography. Method and
results: A referred 46-year-old male with a known history of dyspnea on
exertion for a period of almost three months was admitted to the
hospital with progressive dyspnea, and assessed under suspicion of CAF.
CAF, was seen with a coronary angiogram, but the exact entry point in
the left ventricle or left atrial wall could not be determined. CT
angiography also failed to establish the exact point of entrance to LV
(left ventricle), so CAG (coronary angiography) was repeated with
SonoVue contrast agent injected into LM (Left main) while using a
Siemens echocardiography machine. Multiple views were obtained during
the injection, and revealed unusual flow in the left ventricle just
below the PML (posterior mitral leaflet) postero-lateral and passing
through the fistula to LV. Conclusion: Contrast Enhanced
Echocardiography is thought to be more sensitive and in affording an
accurate delineation of CAF drainage into cardiac chambers, and can be
utilized in a direct precise and safe way.