Introduction Coronary artery fistula (CAF) is a rare cardiac anomaly that typically presents as a continuous murmur in an otherwise asymptomatic patient. Occasionally, it can result in congestive heart failure or bacterial endocarditis. Objective To better delineate the course of coronary artery fistula using an intracoronary injection of SonoVue contrast agent, while performing transthoracic echocardiography. Method and results A referred 46‐year‐old man, with a history of exertional dyspnea for almost 3 months, was admitted to the hospital with progressive dyspnea and assessed under suspicion of CAF. CAF was seen with a coronary angiogram, but the exact entry point in the left ventricle or left atrial wall could not be determined. CT angiography also failed to establish the drainage site, so CAG (coronary angiography) was repeated with the SonoVue contrast agent injected into LM (Left main) while using a Siemens echocardiography machine. Multiple views were obtained during the injection and revealed unusual flow in the left ventricle just below the PML (posterior mitral leaflet) and passing through the fistula to LV. Conclusion Contrast‐enhanced echocardiography by direct intracoronary injection of SonoVue contrast agent is safe and can aid in the delineation of fistula drainage.

Introduction: Coronary artery fistula (CAF) is a rare cardiac anomaly that typically presents as a continuous murmur in an otherwise asymptomatic patient. Occasionally, it can result in congestive heart failure or bacterial endocarditis. Objective: To better delineate the course of coronary artery fistula for the first time, using the SonoVue contrast agent during transthoracic echocardiography. Method and results: A referred 46-year-old male with a known history of dyspnea on exertion for a period of almost three months was admitted to the hospital with progressive dyspnea, and assessed under suspicion of CAF. CAF, was seen with a coronary angiogram, but the exact entry point in the left ventricle or left atrial wall could not be determined.CT angiography also failed to establish the exact point of entrance to LV (left ventricle), so CAG (coronary angiography) was repeated with SonoVue contrast agent injected into LM (Left main) while using a Siemens echocardiography machine. Multiple views were obtained during the injection, and revealed unusual flow in the left ventricle just below the PML (posterior mitral leaflet) postero-lateral and passing through the fistula to LV. Conclusion: Contrast Enhanced Echocardiography is thought to be more sensitive and in affording an accurate delineation of CAF drainage into cardiac chambers, and can be utilized in a direct precise and safe way.

Introduction: Coronary artery fistula (CAF) is a rare cardiac anomaly that typically presents as a continuous murmur in an otherwise asymptomatic patient. Occasionally, it can result in congestive heart failure or bacterial endocarditis. Objective: To better delineate the course of coronary artery fistula using an intracoronary injection of SonoVue contrast agent, whilst performing transthoracic echocardiography. Method and results: A referred 46-year-old male, with a history of exertional dyspnea for almost three months, was admitted to the hospital with progressive dyspnea, and assessed under suspicion of CAF. CAF was seen with a coronary angiogram, but the exact entry point in the left ventricle or left atrial wall could not be determined. CT angiography also failed to establish the drainage site , so CAG (coronary angiography) was repeated with the SonoVue contrast agent injected into LM (Left main) while using a Siemens echocardiography machine. Multiple views were obtained during the injection and revealed unusual flow in the left ventricle just below the PML (posterior mitral leaflet) and passing through the fistula to LV. Conclusion: Contrast-Enhanced Echocardiography by direct intracoronary injection of SonoVue contrast agent, is safe and can aid in the delineation of fistula drainage.

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Background and methods: In this work, 120 patients suspected of having stable angina pectoris were included. They were presented for evaluation of chest pain and to whom clinical evaluation, echocardiography, nuclear scanning and coronary angiography were done. They were classified into group (A) 40 control patients considered as a control group with normal coronaries, and group (B) 80 patients with significant CAD. Results: The study showed that regarding the Echo. Parameters, there were statistically significant difference between the 2 groups regarding the A wave, E/A ration, DT, Em and E/EM. Also regarding SLSS and GLS 17 and GLS 12 as well as SLSr, GLSr 17 and GLSr 12. Significant difference was present regarding number of vessels affected in regard to GLS 12, GLSr 12 and GLSr 17. In comparison with the results of MPI, there was a positive correlation between the number of segments affected in MPI and GLS 12 and GLSr 12. A statistically significant correlation was also found between the 17 segments in MPI and SLSS and SLSr parameters. Conclusion: Myocardial strain by speckle tracking is superior to conventional Echo. Parameters measurements of global and segmental LS using 2DSE and it is a more sensitive tool in the identification of WMA at rest than visual analysis and that support its use to risk stratify atherosclerotic CAD. It may help in identifying which coronary artery is affected.