PMC6450228_01
(a) Diastolic flow from the pulmonary trunk directed upward. (b) Pulsed-wave Doppler confirming typical coronary flow pattern. (c) Coronary-pulmonary fistula from the mid segment of the left anterior descending coronary artery (arrow). (d) Coronary-pulmonary fistula from the right coronary artery (arrow)
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F1
Unexpectedly, parasternal short-axis view showed the presence of diastolic flow from the pulmonary trunk upward [Figure 1a]. Pulsed-wave Doppler confirmed the presence of diastolic flow and displayed the typical coronary flow pattern [Figure 1b]. CPFs originating from the second segment of the left anterior descending coronary [Figure 1c] and the right coronary arteries [Figure 1d]. Clinical and echocardiographic follow-up showed progressive reduction of systolic function, however, with a left ventricular ejection fraction >50% and effort dyspnea.