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Two-dimensional and pulsed Doppler echocardiographic abnormalities in coronary artery-pulmonary artery fistula
Insights
Continuous murmurs often suggest patent ductus arteriosus. However, specific echocardiographic findings in these cases may indicate coronary artery fistulas, a critical alternative diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Continuous murmurs are frequently diagnosed as patent ductus arteriosus (PDA).
- Coronary artery fistulas (CAF) can present with similar auscultatory findings.
- Accurate differentiation is crucial for appropriate patient management.
Abstract:
We describe two patients who presented with precordial continuous murmurs which were diagnosed clinically as due to patent ductus arteriosus; however, two-dimensional echocardiographic and pulsed Doppler echocardiographic studies showed dilatation of the left main coronary artery with turbulent flow during systole in the lumen in both patients. Subsequent selective coronary angiographic studies showed bilateral coronary artery-pulmonary artery fistula in one patient and left coronary artery-pulmonary artery fistula in the other. This study illustrates that in a patient presenting with a continuous murmur which is suggestive of patent ductus arteriosus, such two-dimensional and pulsed Doppler echocardiographic findings as were seen in our patients should immediately alert the physician that he may be dealing with a case of coronary arterial fistula.