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Jing Ping Sun, Liu Yang, Zhen Zhao, Xiaoli Zhang, Genshan Ma, A rare right coronary artery–left ventricular fistula with giant coronary artery and aneurysm, European Heart Journal - Cardiovascular Imaging, Volume 20, Issue 5, May 2019, Page 604, https://doi.org/10.1093/ehjci/jey229
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Extract
A 55-year-old man presented with 1 year of chest pressure. A soft diastolic murmur was present at the left sternal border. The electrocardiogram was normal. 2D transthoracic echocardiography revealed a dilated ascending aorta with a very large right coronary artery (RCA) orifice leading to a very dilated RCA (Panel A). The apical 4-chamber view found a mildly enlarged left ventricle (LV) with normal systolic function. Apical 5-chamber colour Doppler noted mild aortic regurgitation (thin arrow) and abnormal turbulent flow in diastole just beneath the lateral aspect of the mitral annulus (Panel B, thick arrow). This abnormal flow was from the RCA–LV fistula. The markedly dilated RCA with a fistula entering the LV posterior-lateral wall was confirmed with 3D imaging (Panel C, Supplementary data online, Video S1). The computed tomography scan with 3D volume-rendering reconstruction showed a hugely enlarged (diameter 5 cm) RCA with an aneurysm that terminated in the LV wall, consistent with a RCA-to-LV fistula (Panels D–F).