PMC9488586_01
Electrocardiogram: normal, sinus rhythm.
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F1
Table 1 according to the time line of the patient's admission. The patient's electrocardiogram on admission was normal (Figure 1).
Ultrasonic cardiography showed that (A) left ventricle (red arrow) slightly enlarged from the parasternal long axis section view. (B) Apex of left ventricle (red arrow) bulged slightly outward from four-chamber view. (C) Left main coronary artery (red arrow) widened from random view.
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F2
Ultrasonic cardiography (UCG) showed left ventricular ectasia (Figure 2).
Computed tomography angiography showed that the diagonal branch of the left coronary artery was twisted, lengthened, expanded, extended along the left heart margin, and its distal end penetrated the myocardium from the basal segment of the left ventricular posterior edge into the left ventricle. Black arrow shows the thick diagonal branch; red arrow shows coronary artery-left ventricular fistula.
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F3
The patient underwent computed tomography angiography (CTA) examination, which suggested a diagonal branch of coronary artery-left ventricular fistula (Figure 3), and was admitted to the cardiology department.
Cardiovascular magnetic resonance. Suspicious fistula at the base of the inferior lateral wall (red arrow) was seen from the left ventricular short axis at 4 o'clock direction.
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F4
CMR of the heart showed suspicious fistula at the base of the inferior lateral wall (Figure 4) while ICA showed similar findings as CTA (Figure 5).
Invasive coronary angiography also showed that the diagonal branch of the left coronary artery was twisted, lengthened, expanded, extended along the left heart margin, and its distal end penetrated the myocardium from the basal segment of the left ventricular posterior edge into the left ventricle. Black arrow shows the thick diagonal branch; red arrow shows the coronary artery-left ventricular fistula; blue arrow shows the branch of coronary artery fistula that supplies the left ventricular posterior wall myocardium. (A) Right cranial view. (B) Anteroposterior view. (C) Left cranial view.
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F5
CMR of the heart showed suspicious fistula at the base of the inferior lateral wall (Figure 4) while ICA showed similar findings as CTA (Figure 5).