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.