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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram&#44; parasternal short-axis view&#44; with color Doppler applied to the course of the left main&#47;anterior descending artery&#44; showing multiple areas of turbulent flow corresponding to branching of the fistula at this point&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary fistulas are rare malformations with an estimated incidence of &#60;1&#37; in angiographic studies&#46; They are usually diagnosed as incidental findings on coronary angiography&#46; Detection by echocardiography is rarely reported&#59; the most frequent finding is right chamber dilatation&#44; as in most cases the fistula drains directly into the right heart&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 66-year-old woman with permanent atrial fibrillation was admitted for fatigue on moderate exertion&#46; On physical examination&#44; a systolic-diastolic murmur was detected at the left sternal border&#46; She had previously undergone transthoracic echocardiography&#44; which showed normal-sized cardiac chambers&#44; good biventricular function and no significant valve disease&#46; Coronary angiography revealed no angiographic lesions but identified a large coronary fistula arising from the proximal segment of the anterior descending artery and draining into the pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#44; causing a left-to-right shunt&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Further echocardiographic assessment in parasternal view documented dilatation of the pulmonary artery trunk &#40;34 mm&#41; and normal-sized right chambers&#46; Doppler echocardiography identified continuous laminar flow&#44; mainly in diastole&#44; peak velocity 0&#46;1 m&#47;s &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; corresponding to the site of coronary fistula drainage&#46; Areas of turbulent flow were seen along the course of the anterior descending artery&#44; corresponding to branching of the fistula at this point &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; Pulmonary artery pressure was estimated at 28 mmHg&#46; No other congenital defects were detected&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Since the patient was symptomatic&#44; it was decided to perform percutaneous closure&#44; but this was unsuccessful and she subsequently underwent surgical ligation of the fistula&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Almeida I&#44; Caetano F&#44; Trigo J&#44; et al&#46; O ecocardiograma transtor&#225;cico no diagn&#243;stico de uma f&#237;stula coron&#225;ria&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;655&#8211;656&#46;</p>"
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Image in Cardiology
Transthoracic echocardiography in the diagnosis of coronary fistula
O ecocardiograma transtorácico no diagnóstico de uma fístula coronária
Inês Almeida
Corresponding author
inesalm@gmail.com

Corresponding author.
, Francisca Caetano, Joana Trigo, Paula Mota, António Leitão Marques
Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Hospital Geral, Coimbra, Portugal
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Almeida I&#44; Caetano F&#44; Trigo J&#44; et al&#46; O ecocardiograma transtor&#225;cico no diagn&#243;stico de uma f&#237;stula coron&#225;ria&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;655&#8211;656&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Angiographic image of the fistula &#40;yellow arrow&#41; arising from the proximal segment of the anterior descending artery and draining into the pulmonary artery&#46; Left&#58; right oblique cranial view&#59; right&#58; lateral view&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram&#44; parasternal short-axis view&#46; Left&#58; color Doppler showing laminar flow draining into the proximal portion of the pulmonary artery trunk &#40;yellow arrow&#41;&#44; as well as slight pulmonary regurgitation&#59; right&#58; continuous Doppler revealing the flow to be systolic-diastolic &#40;mainly diastolic&#41;&#44; with peak velocity of 1&#46;0 m&#47;s&#46;</p>"
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      2 => array:7 [
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram&#44; parasternal short-axis view&#44; with color Doppler applied to the course of the left main&#47;anterior descending artery&#44; showing multiple areas of turbulent flow corresponding to branching of the fistula at this point&#46;</p>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2014.01.025
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