Acquired coronary-to-left ventricle fistula: evidence by myocardial contrast echocardiography.
The case report subject is a patient with an old anteroseptal myocardial infarction and postinfarction angina who developed, over the years, a small left coronary-to-left ventricle fistula. The first coronary angiogram, performed 4 months after the infarction, was negative for coronary fistula. The diagnosis was made 3 years later, at repeat cardiac catheterization with myocardial contrast echocardiography. Left and right coronary injections of 0.2 cc of sonicated 5% human albumin microbubbles generated a bright cloud of contrast entering the left ventricular cavity at the level of the distal third of the interventricular septum. Conversely, cineangiography failed to show on-line the fistulous communication that was evident only after careful cineangiographic reviewing. This case demonstrates the high efficacy of myocardial contrast echocardiography in identifying very small coronary fistulae.
Voci
P
P
Section of Cardiology II, La Sapienza, University of Rome, Italy.
Mangieri
E
E
Bilotta
F
F
Scibilia
G
G
D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D002933:Cineradiography; D003287:Contrast Media; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005402:Fistula / Q000000981:diagnostic imaging*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications
D003287:Contrast Media