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Innovative method to diagnose Coronary Cameral fistula by contrast echocardiography
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  • Moustafa Eldeib,
  • Fatema Qaddoura,
  • Marawan Sadek,
  • Reda Abuelatta,
  • Ayman Naguib
Moustafa Eldeib
Al-Azhar University Faculty of Medicine
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Fatema Qaddoura
King Fahd Military Medical Complex
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Marawan Sadek
King Fahd Military Medical Complex
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Reda Abuelatta
Madinah Cardiac Center
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Ayman Naguib
Zagazig University
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Abstract

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.

Peer review status:IN REVISION

02 Aug 2020Submitted to Echocardiography
18 Aug 2020Assigned to Editor
18 Aug 2020Submission Checks Completed
18 Aug 2020Reviewer(s) Assigned
20 Sep 2020Review(s) Completed, Editorial Evaluation Pending
20 Sep 2020Editorial Decision: Revise Minor