Korean Circ J.  2013 Apr;43(4):281-283. 10.4070/kcj.2013.43.4.281.

Right Coronary Artery to Left Ventricular Fistula Associated with Infective Endocarditis of the Mitral Valve

• Ahn DS
• Chung JH
• Kim YN
• Oh YS
• Lim DS
• Choi RK

• KMID: 2224954
• DOI: http://doi.org/10.4070/kcj.2013.43.4.281

Abstract

A 27-year-old man with bacterial endocarditis of the mitral valve and embolic episodes was bound to have a large right coronary artery fistula communicating with the left ventricle, immediately inferior to the posterior mitral annulus. The perforation of the posterior leaflet and coronary arteriovenous fistula was identified using two-dimensional Doppler echocardiography. The diagnosis was confirmed by coronary angiography, and the patient underwent a successful operation.

Keyword

Endocarditis, bacterial; Fistula; Coronary vessel anomalies

MeSH Terms

Arteriovenous Fistula
Coronary Angiography
Coronary Vessel Anomalies
Coronary Vessels
Echocardiography, Doppler
Endocarditis
Endocarditis, Bacterial
Fistula
Heart Ventricles
Humans
Mitral Valve

Figure

• 

  Fig. 1 Parasternal long axis echocardiogram showing the echo free space beneath the posterior mitral annulus (large arrowheads) and aneurysmal dilation of the proximal right coronary artery (small arrowheads).

• 

  Fig. 2 A: parasternal short axis echocardiogram showing the site of drainage of the fistulous tract into the left ventricle (arrowheads). B: parasternal short axis echocardiogram with color Doppler showing blood flow from the fistula into the left ventricle (arrowhead).

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  Fig. 3 A: parasternal long axis echocardiogram with color flow Doppler during isovolumetric ventricular contraction showing high velocity turbulent flow striking the posterior mitral leaflet (large arrowhead) near the drainage site of coronary arteriovenous fistula (small arrowheads). B: parasternal long axis echocardiogram with color flow Doppler during diastole showing laminar flow through the perforation of the posterior mitral leaflet (large arrowhead).

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  Fig. 4 Anterioposterior cranial view of the coronary angiogram showing a dilated and tortuous right coronary arteriovenous fistula drainage into the left ventricle (large arrowhead). One normal looking posterior descending artery is observed (small arrowheads).

Reference

1. Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation. 1979. 59:849–854.

2. Rittenhouse EA, Doty DB, Ehrenhaft JL. Congenital coronary arterycardiac chamber fistula. Review of operative management. Ann Thorac Surg. 1975. 20:468–485.

3. Ong ML. Endocarditis of the tricuspid valve associated with congenital coronary arteriovenous fistula. Br Heart J. 1993. 70:276–277. discussion 277-8.

4. Lee CW, Sung SH, Yu WC. Coronary artery fistula with a huge aneurysm formation presenting as heart failure. Korean Circ J. 2012. 42:69–70.

5. Edwards JE. Mitral insufficiency secondary to aortic valvular bacterial endocarditis. Circulation. 1972. 46:623–626.

6. Miyatake K, Okamoto M, Kinoshita N, Fusejima K, Sakakibara H, Nimura Y. Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique. Br Heart J. 1984. 51:508–518.

7. Kimball TR, Daniels SR, Meyer RA, Knilans TK, Plowden JS, Schwartz DC. Color flow mapping in the diagnosis of coronary artery fistula in the neonate: benefits and limitations. Am Heart J. 1989. 117:968–971.