Introduction
Congenital CAF is an uncommon cardiac anomaly that usually presents with
a continuous murmur in otherwise asymptomatic patients (1).
Occasionally, it leads to congestive heart failure or bacterial
endocarditis (1-3). If fistulas remain undetected or untreated in
childhood, they reportedly (1, 3) become symptomatic more frequently in
adulthood due to chronic volume overload and myocardial ischemia.
Although spontaneous closure can occur sporadically (4, 5), Among the
treatment options, an elective surgical closure 1, 3,6,7) or
percutaneous closure in the cardiac catheterization laboratory. To
enable successful and safe closure, it is imperative to define the
anatomy of the fistula. (15)
A large fistula can occasionally appear as a mass lesion on
echocardiography, the course of the fistula can be difficult to confirm
by echocardiography. Here, we report a new diagnostic approach to
identifying CAF, using an intracoronary injection of SonoVue contrast
agent, whilst performing transthoracic echocardiography.