title: The dilemma of evaluating a continuous murmur in a patient of aneurysm of sinus of Valsalva and coronary cameral fistula presenting with supraventricular tachycardia.
abstract: A 39-year-old hypothyroid woman on thyroxine replacement therapy presented with an unresolving episode of palpitations (narrow-complex tachycardia). Clinical examination, after reversion to normal sinus rhythm revealed a precordial continuous murmur. Initial transthoracic echocardiogram showed an unruptured aneurysm of left sinus of Valsalva (LSOV), however, because a continuous murmur could not be explained by this condition, a repeat colour Doppler study was made, revealing a communicating tract from the left main coronary artery (LMCA) and terminating in the right atrium (RA). A transesophageal echocardiogram revealed an aneurysmal LMCA and LSOV, with similar colour Doppler findings. A further CT scan and coronary angiogram confirmed a coronary cameral fistula opening into RA. In conclusion, the relevance of a diligent clinical examination and imaging after conversion to normal sinus rhythm in picking up such anomalies cannot be over-emphasised, as previous routine echocardiograms on the same patient had been reported as normal.
authors.affiliation: Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Yashasvi
authors.initials: Y
authors.lastname: Chugh
authors.affiliation: Interventional Cardiology Consultants Inc & Consultant, Department of Cardiology, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chugh
authors.affiliation: Department of Cardiology, Delhi Heart and Lung Institute, Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Chugh
mesh_terms: D000328:Adult; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis*; D001019:Aortic Rupture; D017023:Coronary Angiography; D054326:Coronary Sinus; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis; D003331:Coronary Vessels / Q000473:pathology*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D005402:Fistula / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006325:Heart Atria / Q000473:pathology*; D006337:Heart Murmurs / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D012850:Sinus of Valsalva / Q000473:pathology*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000209:etiology