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 using an intracoronary injection of
SonoVue contrast agent, whilst performing transthoracic
echocardiography. Method and results: A referred 46-year-old male, with
a history of exertional dyspnea for 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 drainage site , so CAG
(coronary angiography) was repeated with the 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) and passing through the fistula to LV. Conclusion:
Contrast-Enhanced Echocardiography by direct intracoronary injection of
SonoVue contrast agent, is safe and can aid in the delineation of
fistula drainage.