PMC6710726_01
Midventricular (a) and basal (b) short axis view and 2-chamber (c) with color Doppler, showing fistula's course in the left ventricle inferoposterior wall (arrows). (d) PW-Doppler recording fistula flow that is predominantly diastolic.
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fig1
Pulsed Doppler sample volume positioned at the level of the flow into the left ventricle confirmed that it was a diastolic flow (Figure 1).
Coronary angiography: right coronary artery stenosis of 50% at the end of the proximal portion. Presence of a tortuous voluminous coronary fistula (arrow).
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fig2
The terminal portion of the fistula (approximately two-millimeter vessel diameter) crossed the inferoposterior wall of the left ventricle under the mitral annulus, and with a phasic flow, typically diastolic, it went into the ventricular cavity (Figure 2).
Three-dimensional (3D) reconstruction of the right coronary artery and fistula using computed tomography angiography.
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fig3
CT was performed to detect coronary fistula anatomy, its relationships with cardiac structures and its course. CT images documented that coronary fistula originated from the distal portion of the right coronary artery, ran into the left ventricular inferior wall, and drained into the left ventricular chamber under the mitral valve, with a final tract with an intramyocardial course (Figure 3).