Hemodynamic Significance of Coronary Cameral Fistula Assessed by Fractional Flow Reserve
A 59-year-old man was referred to our department for further investigation of abnormal findings on an echocardiography. He had a history of hypertension and cerebral hemorrhage. He suffered distal interphalangeal joint deformity in his right third finger and underwent routine preoperative evaluation. His electrocardiogram (ECG) and chest X-ray were normal. Transthoracic echocardiography showed an abnormal Doppler color flow, through the left ventricle (LV) wall to the basal part of the ventricular cavity. Left ventricular systolic and diastolic functions were normal with normal chamber sizes. Selective coronary angiography demonstrated a normal right coronary artery. The left anterior descending artery (LAD) and the left circumflex artery (LCX) were large and tortuous without stenosis. They merged at the end of their course near the basal inferoposterior wall of the LV, and formed a huge fistulous track draining into the LV cavity (). Due to its large size, FFR was measured in both arteries. During hyperemia, obtained by an intravenous adenosine infusion (140 µg/kg/min), the FFR values were 0.93 in the LAD and 0.97 in the LCX (). The LV end-diastolic pressure was normal (11 mm Hg). He subsequently completed 17 minutes of a treadmill test (Bruce protocol) without chest pain and abnormal ECG changes. Due to the lack of symptom and evidence of hemodynamic compromise, we decided to leave the fistula alone and follow the patient closely. He had undergone an orthopedic surgery, uneventfully.