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.