PMC4349104_01
A 35-year-old woman with recurrent attacks of palpitation since childhood. A) Transthoracic color Doppler echocardiography shows the dilated left circumflex artery (arrow) emptying into the big coronary sinus. B) Continuous turbulence flow on color Doppler at the level of coronary artery-coronary sinus connection as well as in the coronary sinus indicating a left-to-right shunts flow.
iranjradiol-12-01-6878-g001.jpg
PMC4349104_01_iranjradiol-12-01-6878-g001.jpg
fig15033
Transthoracic 2-dimensional echocardiography demonstrated dilation of both the atrium and left circumflex artery with a maximum diameter of 15 mm Color Doppler echocardiography showed the course of the left circumflex artery emptying into the coronary sinus (Figure 1 A).
Axial (top left) and reconstructed images (top right and bottom) of coronary CT shows the dilated left circumflex artery (arrow) arising from the left coronary cusp and drains into the right atrium (*). AO = Aorta, CS = Coronary sinus, LA = Left atrium, LCX = Left circumflex artery, LV = Left ventricle, LVOT = Left ventricular outflow tract, PA = Pulmonary artery, RA = Right atrium
iranjradiol-12-01-6878-g002.jpg
PMC4349104_01_iranjradiol-12-01-6878-g002.jpg
fig15034
The CT scan revealed a tortuous fistulous communication between the left circumflex artery and the coronary sinus 13.6 mm in diameter for the left circumflex artery and 11.8 mm (axial) and 24 mm (coronal) diameter for the coronary sinus (Figures 2 and 3).
Volume rendering images of coronary CT show dilated left circumflex artery (Cx) (arrow).
iranjradiol-12-01-6878-g003.jpg
PMC4349104_01_iranjradiol-12-01-6878-g003.jpg
fig15035
The CT scan revealed a tortuous fistulous communication between the left circumflex artery and the coronary sinus 13.6 mm in diameter for the left circumflex artery and 11.8 mm (axial) and 24 mm (coronal) diameter for the coronary sinus (Figures 2 and 3).
Coronary angiography (anteroposterior view) demonstrates contrast opacified left circumflex artery that is markedly dilated. CS = Coronary sinus, LCX = Left circumflex artery, LM = Left main coronary artery
iranjradiol-12-01-6878-g004.jpg
PMC4349104_01_iranjradiol-12-01-6878-g004.jpg
fig15036
The patient was referred for cardiac catheterization, which confirmed a giant coronary arterial-venous (A-V) fistula arising from a dilated and mildly tortuous circumflex artery (Figure 4).