NONINVASIVE DIAGNOSIS AND MANAGEMENT OF CORONARY ARTERIOVENOUS-FISTULA - A CASE-REPORT

Coronary arteriovenous fistulas are rare anomalies resulting in abnorm al communication between the coronary artery and any chamber of the he art. An asymptomatic patient was referred for evaluation of her murmur . Two-dimensional and color Doppler echocardiographic evaluation revea led an enlarged left main coronary artery. A retrograde, eccentric sme ll jet was found within the right ventricular outflow tract at the pul monary artery valvular level allowing us to detect the entrance she of the fistula. The diagnosis was confirmed by cardiac catheterization a nd angiocardiography. Although our case was asymptomatic, the decision to perform cardiac surgery was made because of the aneurysmatic appea rance of the left coronary artery. In our opinion, visualization of co ronary arteries by two-dimensional echocardiography, together with add itional information obtained from the Doppler examination, provides an excellent technique for the noninvasive diagnosis of coronary artery fistula.