Innovative method to diagnose coronary Cameral fistula by contrast echocardiography.
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, while performing transthoracic echocardiography.


METHOD AND RESULTS
A referred 46-year-old man, with a history of exertional dyspnea for almost 3 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.
['Eldeib|Moustafa|M|0000-0002-5385-4064', 'Qaddoura|Fatema|F|', 'Sadek|Marwan|M|', 'Abuelatta|Reda|R|', 'Nagib|Ayman|A|']
D017023:Coronary Angiography D003324:Coronary Artery Disease D003330:Coronary Vessel Anomalies D004452:Echocardiography D005402:Fistula D006330:Heart Defects, Congenital D006352:Heart Ventricles D006801:Humans D008297:Male D008875:Middle Aged
contrast echocardiography coronary artery fistula (CAF) heart failure