Failure of color flow mapping to identify coronary artery to pulmonary artery fistula

Abstract

A case of coronary artery to pulmonary artery fistula presented with the typical clinical findings of asymptomatic precordial continuous murmur and small left-to-right shunt. Echocardiography with color flow mapping failed to demonstrate the fistula on three occasions, including one study performed after angiographic demonstration of the fistula site. This case illustrates the importance of angiography in patients with unexplained continuous murmurs, even when echocardiographic and color flow mapping results are normal.

Incidental Finding of a Right Coronary Artery to Coronary Sinus Fistula in an Adult Transthoracic Echocardiogram

“…False-positive and falsenegative CAF diagnoses have occurred previously. 21 Treatment for CAF is dependent on the anatomy and size of the fistula, presence of symptoms, and concomitant cardiovascular disease. Small, asymptomatic CAFs in adults do not need transcatheter or surgical intervention and are usually managed conservatively.…”