title: Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient.
abstract: Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stress-induced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.
authors.affiliation: Cardiology Department, Hospital de S Marcos, Apartado 2242, 4701-965 Braga, Portugal. sergionnabais@gmail.com
authors.forename: Sérgio
authors.initials: S
authors.lastname: Nabais
authors.forename: Nuno
authors.initials: N
authors.lastname: Salomé
authors.forename: Aida
authors.initials: A
authors.lastname: Brandão
authors.forename: Alda
authors.initials: A
authors.lastname: Simões
authors.forename: Jorge
authors.initials: J
authors.lastname: Marques
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.forename: Luís
authors.initials: L
authors.lastname: Basto
authors.forename: António
authors.initials: A
authors.lastname: Costeira
authors.forename: Adelino
authors.initials: A
authors.lastname: Correia
mesh_terms: D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000473:pathology; D003310:Cor Triatriatum / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D012008:Recurrence; D016157:Vascular Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology