Noninvasive detection of a coronary arteriovenous fistula by two-dimensional color Doppler echocardiography

The diagnosis of a left circumflex coronary artery--coronary sinus fistula draining into the right atrium was confirmed by echocardiographic analysis. Two-dimensional echocardiography revealed a dilatation of the left main coronary artery, the left circumflex artery, the coronary sinus and a fistulous communication. Pulsed Doppler echocardiographic study showed a turbulent, continuous flow within the dilated coronary artery, in the coronary sinus and at the site of its drainage into the right atrium. There was a diastolic flow-reversal in the descending aorta in absence of aortic insufficiency. Color Doppler echocardiography enhanced the finding of the correct diagnosis by simultaneously displaying blood flow within various parts of the heart and the coronary vessels. This technique aided in establishing the exact location of the fistula by demonstrating a turbulent blood flow, even in narrow cardiac structures. The echocardiographic diagnosis was confirmed by coronary angiography.