Circulation. 2001;103:2028-2029
(Circulation. 2001;103:2028.)
© 2001 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Left Main Coronary Artery to Left Atrial Fistula Causing Mild Pulmonary Hypertension
Dimitris Tousoulis, MD, PhD;
Stella Brilli, MD;
Konstantina Aggelli, MD;
Costas Tentolouris, MD;
Christodoulos Stefanadis, MD;
Kostantinos Toutouzas, MD;
Alexandra Frogoudaki, MD;
Pavlos Toutouzas, MD
From the Cardiology Unit, Athens University Medical School, Hippokration
Hospital, Athens, Greece.
Correspondence to Dimitris Tousoulis, MD, PhD, Athens University Medical School, S Karagiorga 69, 16675 Athens, Greece.
A 73-year-old
man with a 6-month history of exertional chest tightness and dyspnea
was referred for evaluation. No risk factors for coronary
atherosclerosis were present. Left cardiac catheterization revealed
coronary arteries without significant stenoses and mildly impaired left
ventricular function (ejection fraction, 55%). A fistula from the main
stem of the left coronary artery to the left atrium was visualized
during coronary arteriography
(Figure 1
). Right cardiac catheterization showed the
following: pulmonary artery pressure of 45/22 mm Hg (mean, 30 mm Hg),
right ventricular pressure of 45/8 mm Hg, and mean pulmonary
capillary wedge pressure of 14 mm Hg (V wave, 30 mm Hg).
Echocardiography showed an increased left atrial diameter (49 mm) and
normal thickness and dimensions of the left ventricle (end-diastolic
diameter of 50 mm and end-systolic diameter of 35 mm). A
transesophageal echocardiogram in the short-axis projection revealed
abnormal flow across the aortic wall into the left atrium
(Figure 2). Pulsed Doppler revealed continuous flow at the
left atrial end of the fistula
(Figure 3). In this case, the symptoms were controlled with a
diuretic and an ACE inhibitor, and a follow-up echocardiogram was
arranged.
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Figure 1. Angiogram with catheter tip in left coronary artery. Fistula (arrows) from main stem of left coronary artery (arrow A) to the left atrium (arrow B) is evident.
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Figure 2. Transesophageal echocardiogram in short-axis projection shows abnormal flow across aortic wall into left atrium (arrows).
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