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[Right and left coronary arteries-right atrial fistulas diagnosed by Doppler echocardiography: a case report]
A Kawamura1, N Tsuyuguchi, H Ohtani
1Department of Internal Medicine, Kenritsu Amagasaki Hospital.
Insights
This case report highlights the successful diagnosis of coronary arteriovenous fistulas using Doppler echocardiography. This noninvasive technique accurately identified abnormal connections between the coronary arteries and the right atrium.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Medicine
Background:
- Coronary arteriovenous fistulas (CAVF) are rare congenital or acquired abnormalities.
- Diagnosis often relies on invasive methods like coronary angiography.
Observation:
- A 59-year-old woman presented with a continuous murmur and thrill.
- Echocardiography revealed dilated coronary arteries and tortuous fistulas converging into the right atrium.
Findings:
- Doppler echocardiography detected bidirectional turbulent flow in the coronary arteries and fistulas.
- High flow velocity (approx. 2 m/s) was measured at the right coronary artery ostium, correlating with the thrill.
- Selective coronary angiography confirmed the fistulas and their communication with the right atrium.
Implications:
- Doppler echocardiography offers a valuable noninvasive method for diagnosing coronary arteriovenous fistulas.
- This imaging modality can guide further management and potentially reduce the need for invasive procedures.
Abstract:
An interesting case of right and left coronary arteries-right atrial fistulas diagnosed by Doppler echocardiography was presented. A 59-year-old woman was referred for evaluation of her continuous murmur. A thrill was palpable at the left sternal border in the third intercostal space. The proximal portions of the dilated right and left coronary arteries and distal portions of the tortuous and converging fistulas of both coronary arteries were imaged by two-dimensional echocardiography. Bidirectional continuous turbulent Doppler signals were detected in the proximal portions of the dilated right and left coronary arteries, in the distal portions of the fistulas around the crux and in the right atrium. These findings facilitated our diagnosis of right and left coronary arteries-right atrial fistulas. The flow velocity at the ostium of the right coronary artery was highest and nearly the same as the flow velocity (about 2 m/s) obtained by continuous wave Doppler from the maximum point of the thrill. The maximum pressure difference was considered located at this portion. Selective coronary angiography confirmed the right coronary artery and left main trunk-left circumflex coronary artery to be large, elongated and tortuous. These fistulas were communicating with the right atrium. This case demonstrates the usefulness of Doppler echocardiography in the noninvasive diagnosis of coronary arteriovenous fistula.