Prenatal Diagnosis of a Right Coronary-Cameral Fistula

Abstract

congenital coronary-cameral fistula involves an abnormal fistulous connection between a coronary artery and a cardiac chamber. Most often, a fistula from the right coronary artery (RCA) to the right ventricle (RV) occurs in association with pulmonary atresia, but coronary fistulas without pulmonary stenosis have been reported. 1 We report the case of a prenatal diagnosis of an isolated RCA fistula to the RV. Case ReportA fetus at a gestational age of 20 weeks 4 days was referred for echocardiography because of a questionable congenital cardiac anomaly detected during a routine obstetric scan. An asymmetric 4-chamber view with a markedly enlarged right heart was first scanned ( Figure 1A). A turbulent flow from the lateral margin of the right heart back into the RV was shown in a 4-chamber view ( Figure 1B). The pulmonary artery (1.38 cm) and aortic root (1.12 cm) on the 3 great-vessel views ( Figure 1C) were disproportionate in size. In the short axis view of the aortic root, the origins of the left and right coronary arteries were found to be dilated ( Figure 1D), which was further shown with power Doppler imaging (Figure 2A). Power Doppler imaging also showed the dilated RCA and its connection with the RV through a fistulous tract ( Figure 2B). The 3-dimensional function on power Doppler sonography also showed the RCA fistula ( Figure 2C). Color Doppler flow imaging confirmed the presence of to-and-fro flow across the fistula near its insertion into the RV ( Figure 2D). We did follow-up sonographic examinations on the fetus every 2 to 3 weeks. The progressive dilatation of the RCA was recorded. The size of the RCA at its opening from the aortic root was 0.38 cm at 20 weeks 4 days; it was 0.661 cm at 37 weeks 1 day. Fetal tachycardia as high as 176 beats/min was recorded at the first sonographic scan-

Prenatal Diagnosis of Bilateral Ventriculocoronary Fistulas With Hypoplasia of the Left Ventricle

“…There have been only a few reports of prenatal diagnosis of ventriculocoronary communications in HRHS and HLHS. [1][2][3][4][5][6][7][8][9] Here we report prenatal diagnosis of HLHS and fistulas between the left ventricle and both the right and left coronary arteries to the pulmonary artery with a muscular ventricular septal defect (VSD) in a fetus at 23 weeks' gestation.…”

Prenatal diagnosis of isolated coronary artery fistulas: progression and outcome in five cases

“…These patients had attempted catheter or surgical closure in the newborn period or early infancy. [12][13][14][15][16] The optimal timing for transcatheter or surgical closure of a coronary artery fistula in asymptomatic patients is unclear. 17 Occasionally, complications may be encountered even after transcatheter closure.…”

“…Prenatal diagnosis of isolated coronary artery fistula is rare, with only few case reports published thus far. [11][12][13][14][15][16] We first reported the prenatal detection and progression of a right coronary artery-to-right ventricular fistula in one case in 1996. 21 The diagnosis can be made in fetal life by cross-sectional and colour Doppler echocardiography.…”

Prenatal Diagnosis of Coronary Artery Fistula: A Case Report and Review of Literature

“…As a result, nine case reports of prenatally diagnosed isolated CAF have been published since 1996. 2 3 4 5 6 7 8 9 10 In this report, we describe a case of a prenatally diagnosed RCA fistula to RV with some novel aspects, followed by a literature review of the echocardiographic findings, management and outcomes of prenatally diagnosed isolated CAF.…”