Coronary artery to left ventricle fistula

We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow.The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.Communications between coronary arteries and cardiac chambers are likely congenital in origin. [1] However, in certain instances they might be acquired and is usually secondary to either trauma or after invasive cardiac procedures [2-8]. Physiologic derangements depend on the site of origin, size of the fistulae and on the receiving chamber [1,9-11]. It has been reported that the right coronary artery is the most likely site and the right ventricle the major receiving chamber [1,9]. We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up and while asymptomatic, an abnormal continuous color flow signal with a predominant diastolic component, consistent with coronary arterial flow, traversing the septum into the left ventricle was identified.A 74-year-old female with a history of severe aortic stenosis and interventricular septal hypertrophy underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. Two months after the surgical intervention she presented to another hospita