J Cardiovasc Ultrasound.  2012 Jun;20(2):108-111. 10.4250/jcu.2012.20.2.108.

Multiple Fistula Emptying into the Left Ventricle through the Entire Left Ventricular Wall

• Lee DY
• Park SH
• Bae MH
• Lee JH
• Yang DH
• Park HS
• Cho Y
• Chae SC
• Jun JE

• KMID: 2177376
• DOI: http://doi.org/10.4250/jcu.2012.20.2.108

Abstract

Coronary artery fistulae are usually identified during invasive coronary angiographies. However, in this case, we made the early detection of coronary artery fistulae during non-invasive transthoracic echocardiography, by demonstrating diastolic multiple abnormal color Doppler flows on the entire left ventricular walls including left ventricular free wall, interventricular septum and apex, which were mimicking firecracker on the whole left ventricle. Fistulous communication from the coronary artery to the left ventricle is rare. Moreover, a case of multiple coronary fistulae emptying into the left ventricle through the entire left ventricular walls including left ventricular free wall, interventricular septum and apex is uncommon. We report a case of a 31-year-old woman who was diagnosed with multiple fistula communicating with entire left ventricular wall.

Keyword

Multiple fistula; Left ventricle; Firecracker

MeSH Terms

Adult
Coronary Angiography
Coronary Vessels
Echocardiography
Female
Fistula
Heart Ventricles
Humans

Figure

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  Fig. 1 Electrocardiography showing biphasic T wave in lead V1-3.

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  Fig. 2 Transthoracic parasternal long axis, short axis and apical four chamber view: Note the sinusoidal mesh like structure in the basal anteroseptum wall, and multiple sparkling color Doppler flows through the entire left ventricular walls during diastole.

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  Fig. 3 The computerized tomographic angiography showing multiple fistula draining into left ventricular cavity through interventricular septum and apex (arrows): Coronary artery had markedly tortuous and dilated morphology from left main coronary artery to left anterior descending artery.

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