A Rare Coronary Anomaly in the Adult: Large-Caliber Arteriovenous Fistula

Case description

A 57-year-old Caucasian male patient with a past medical history of hypertension and pulmonary emphysema presented to the Cardiology outpatient clinic with exertional dyspnea, peripheral edema, orthopnea, and new-onset atrial fibrillation, with a III/VI continuous murmur, raising the possibility of an intrathoracic arteriovenous communication.

A transthoracic echocardiogram revealed a dilated left ventricle with mildly reduced global systolic function (ejection fraction of 44%), biatrial enlargement, and mild pericardial effusion. Notably, this study showed multiple ‘rosary-like’ folds (, , Supplementary Videos S1-S2) with color Doppler flow, revealing a possible coronary fistula. The Qp/Qs ratio was normal. ^,

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