Introduction
Congenital CAF is an uncommon cardiac anomaly that usually presents with a continuous murmur in otherwise asymptomatic patients (1). Occasionally, it leads to congestive heart failure or bacterial endocarditis (1-3). If fistulas remain undetected or untreated in childhood, they reportedly (1, 3) become symptomatic more frequently in adulthood due to chronic volume overload and myocardial ischemia. Although spontaneous closure can occur sporadically (4, 5), elective surgical closure is the preferred mode of treatment (1, 3,6,7).
A large fistula can occasionally appear as a mass lesion on echocardiography, but cannot easily be confirmed. Here, we report a new diagnostic approach to identifying CAF, using a contrast agent injected into the left coronary artery and transthoracic echocardiography. The case described related to a 46-year-old male suffering from dyspnea with turbulent flow in the left ventricle.