Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient

• Published in: European journal of echocardiography Vol. 9; no. 5; pp. 712 - 715
• Main Authors: Nabais, Sérgio, Salomé, Nuno, Brandão, Aida, Simões, Alda, Marques, Jorge, Costa, João, Basto, Luís, Costeira, António, Correia, Adelino
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2008
• Subjects: 80 and over; Aged; Aged, 80 and over; Angina; Chest Pain; Chest Pain - diagnostic imaging; Chest Pain - pathology; Ciências Médicas; Congenital heart disease; Cor Triatriatum; Cor Triatriatum - complications; Cor Triatriatum - diagnostic imaging; Cor Triatriatum - pathology; Coronary artery disease; Coronary artery fistulae; Echocardiography; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Humans; Male; Medicina Básica; Myocardial Ischemia; Myocardial Ischemia - complications; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - pathology; Recurrence; Transesophageal; Vascular Fistula; Vascular Fistula - complications; Vascular Fistula - diagnostic imaging; Vascular Fistula - pathology; Cor triatriatum; Three-dimensional echocardiography; Congenital heart disease; Angina; Coronary artery fistulae; Coronary artery disease
• ISSN: 1525-2167; 1532-2114
• DOI: 10.1093/ejechocard/jen140

Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1
). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stress-induced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.