Coronary artery to left ventricle fistula

Abstract

Background: Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle.

Case presentation: We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow.

Conclusion: The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

Figure 1

Parasternal long axis view showing an abnormal color flow signal arising from a thick interventricular septum with a predominant flow away from the transducer into the left ventricular cavity. A predominant diastolic component is shown. The position of the pacer wire and prosthetic aortic valve are also shown. (RV = right ventricle, LV = left ventricle, LA = left atria).

Figure 2

Similar parasternal image showing the predominantly diastolic color flow image component. (RV = right ventricle, LV = left ventricle, LA = left atria).

Figure 3

Short axis view showing the color flow signal with regards to the septum. (RV = right ventricle, LV = left ventricle, LA = left atria).