Contrast Echo-A Simple Diagnostic Tool for a Coronary Artery Fistula

Abstract

Coronary artery fistulas have been diagnosed with aortography, coronary angiography, and coronary computed tomography (CT). A large fistula can be occasionally found as a mass lesion on echocardiography but cannot be easily confirmed. Here, we report a new diagnostic approach to coronary artery fistulas using a contrast agent and transthoracic echocardiography. Transthoracic echocardiography of a 46-year-old female suffering from dyspnea revealed suspicious small turbulent flow in the main pulmonary artery. Following infusion of a contrast agent, we found whitish flow in the main pulmonary artery during the diastolic phase, and aortic CT revealed two huge right coronary artery fistulas in the main pulmonary artery. A simple diagnostic approach to a coronary artery fistula using contrast agent helped us confirm the diagnosis because of the typical diastolic whitish flow in the pulmonary artery.

Right Coronary Artery-Superior Vena Cava Fistula Manifesting as NSTEMI: Case Report, Review of Imaging, and Summary of Guidelines

“…Echocardiographic evaluation, both TTE and TEE, is limited by fields of view and operator dependency, but can delineate CAF anatomy, and analyze CAF associated hemodynamic and physiologic changes while avoiding radiation exposure [19,22]. Use of micro-bubble contrast can enhance echocardiography by more precisely determining the extent and location of the CAF, but has diminished utility in CAFs with distal arterial origins [19,23,24]. Current guidelines refer to the use of surveillance echocardiography every 3–5 years for follow up of patients with small and asymptomatic CAF to monitor for fistula progression and terminating chamber enlargement [17].…”

Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine-13N-ammonia PET-CT

“…One study reported the diagnosis of a small coronary-pulmonary fistula (CPF) by echocardiography in asymptomatic dizygotic twin infant brothers[ 31 ], suggesting a possible genetic cause of CAFs. Invasive CAG is considered the gold standard for the detection and diagnosis of congenital CAFs; however, non-invasive imaging techniques such as contrast echocardiography[ 34 ], 2D and color Doppler echocardiography, cardiovascular MRI and CTCA provide valuable complementary data for the visualization of fistula components (origin, pathway and termination sites) that are not visible on the CAG[ 20 , 35 - 37 ].…”

Wire Perforation or Coronary-Cameral Fistula? A Diagnostic Dilemma Complicating a Case of ST-Segment Elevation Myocardial Infarction

“…The use of echocardiography contrast for the localization of coronary-cameral fistulas has been previously described. 13 , 14 It is important to note that this is an off-label use of echocardiography contrast and that intra-arterial injection is listed as contraindicated on the contrast product label. This simple diagnostic procedure confirmed the coronary-cameral fistula location and excluded a life-threatening complication of infarct angioplasty.…”