[Right and left coronary arteries-right atrial fistulas diagnosed by Doppler echocardiography: a case report].

An interesting case of right and left coronary arteries-right atrial fistulas diagnosed by Doppler echocardiography was presented. A 59-year-old woman was referred for evaluation of her continuous murmur. A thrill was palpable at the left sternal border in the third intercostal space. The proximal portions of the dilated right and left coronary arteries and distal portions of the tortuous and converging fistulas of both coronary arteries were imaged by two-dimensional echocardiography. Bidirectional continuous turbulent Doppler signals were detected in the proximal portions of the dilated right and left coronary arteries, in the distal portions of the fistulas around the crux and in the right atrium. These findings facilitated our diagnosis of right and left coronary arteries-right atrial fistulas. The flow velocity at the ostium of the right coronary artery was highest and nearly the same as the flow velocity (about 2 m/s) obtained by continuous wave Doppler from the maximum point of the thrill. The maximum pressure difference was considered located at this portion. Selective coronary angiography confirmed the right coronary artery and left main trunk-left circumflex coronary artery to be large, elongated and tortuous. These fistulas were communicating with the right atrium. This case demonstrates the usefulness of Doppler echocardiography in the noninvasive diagnosis of coronary arteriovenous fistula.