Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique.

Abstract

SUMMARYThe Doppler echocardiographic features of coronary arteriovenous fistula were investigated in eight patients with left or right coronary arteriovenous fistulas who had a continuous heart murmur in the upper precordial area and whose diagnoses were confirmed by coronary angiography. In four patients the dilated lumen of the coronary arteriovenous fistula was visualised by cross sectional echocardiography. Of these, three showed abnormal unidirectional continuous flow signals with broad velocity spectra in the fistula. Abnormal, powerful, unidirectional Even with cross sectional echocardiography, however, the site of the shunt-that is, the opening of the fistula-cannot always be detected.In the present study we attempted to identify the coronary arteriovenous fistula, detect the shunt site, and determine the haemodynamic conditions inside the fistula using cross sectional echocardiography and the Doppler technique.Requests for reprints to Dr Kunio Miyatake, National Cardiovascular Center, 125 Fujishiro-dai 5-chome, Suita, Osaka 565, Japan.Accepted for publication 20 December 1983 Patients and methods Eight patients (five men, three women; age range 22-64 years) with a coronary arteriovenous fistula were examined. They were referred to the National Cardiovascular Center for cardiac catheterisation and angiocardiography because of a continuous heart murmur in the upper precordial area, although their exertion capacity was satisfactory. Coronary angiography showed that the continuous heart murmur originated from a coronary arteriovenous fistula. DOPPLER TECHNIQUEThe equipment used included two commercially available cross sectional echocardiographs, a Toshiba SSH 11A/SDS 10A and a SSH 40A/SDS 21A, which incorporated a pulsed Doppler flowmeter in an ultrasonic wide angle phased array system. The ultrasonic frequency used was 2*4 MHz and the pulse repetition rates were 4 and 6 kHz. The sample volume was tear-drop shaped and its size was 4 mm in width 508 on 9 May 2018 by guest. Protected by copyright.

Usefulness and Limitation of Transthoracic Echocardiography in the Diagnosis of Large Coronary Artery Fistula

“…It is not rare that color Doppler TTE cannot detect flow signal in the distal portion of CAF. Previous studies have indicated that it was extremely hard to depict CAF by TTE, particularly in the cases having the left anterior descending coronary artery as the feeding vessel 6, 7, 9 . In addition, the CAF cases with the drainage site in the pulmonary artery were also reported to be difficult to fully detect by TTE, because the feeding coronary artery was not dilated 8, 10 .…”

“…Recent accumulating case reports have shown that multidetector computed tomography (MDCT) could be an alternative imaging modality of choice for CAF by its high temporal and spatial resolution power 1–3 . Although transesophageal echocardiography (TEE) has also been shown to be useful in the diagnosis of CAF, role of transthoracic echocardiography (TTE) in the diagnostic process for CAF remains controversial 4–10 . We describe our experience with three unusual cases of large CAF, in which TTE played a crucial role during the diagnostic process.…”

Right Coronary Artery to Left Ventricular Fistula Associated with Infective Endocarditis of the Mitral Valve

“…Two dimensional echocardiography has its limitations in diagnosing coronary arteriovenous fistula but has been an important procedure in establishing the diagnosis in most cases 6)7). In our case, the proximal portion, the drainage site of coronary arteriovenous fistula, and the perforation of the posterior mitral leaflet were clearly demonstrated by two dimensional echocardiography.…”

Congenital Coronary Artery Fistula in Infancy and Childhood: Diagnostic and Therapeutic Aspects

“…vessel is sufficient, a conti nuous or turbul ent flow within the fistula or at the site of termination can be visualized by pulsed Doppler sonography (13)(14)(15). If the shunt volume is marked.…”

“…In th e second so-called "d istal"form of CA F (type B) the coronary artery or a bran ch th ereof wa s dilated over th e entire course to finally termin at e as a fistu la w it hin th e righ t side of th e heart ("end ar te ry type", 12 ). Proxima l to the fistula a 14)of th e left coronary artery (LCA) to dra in into the right atr ium (patie nts 8,13,14) and/or into the coronary sinus (patients 13,15). In four add itional patient s (patients 9,10,1 1,12) the left anterior descend ing artery term inated into the right-vent ricular outfl ow tract afte r giving off normal diagonal branches (Fig.6 a, b).…”