INTRODUCTION: Congenital coronary cameral fistulas (CCCF) are an uncommon clinical entity, presenting an abnormal fistulous communication between a coronary artery and a cardiac chamber. These fistulas most commonly result from congenital abnormalities leading to neovascularization. These fistulas usually terminate directly in a cardiac chamber, most often in the right ventricle. Here we describe a case with atypical CCCF of left anterior descending coronary artery (LADCA) at the apex of right ventricle, mimicking muscular ventricular septal defect.
METHOD: Case presentation of an asymptomatic child with apical CCCF.
CASE PRESENTATION: A three –years -old girl was referred at our institution for the heart murmur and cardiac examination. Basic condition was well within normal growing and physical activity. By auscultation a short systolic murmur at the apex, grade 3-4/6 was noted. ECG and X Ray-chest was normal. 2D transthoracic echocardiography imaging shows normal both ventricles and normal regional and global contractility. 2D imaging in the parasternal short axis view shows dilated main left and left anterior descending coronary artery and the normal size of the right coronary artery. Using low scale of Collor-Doppler long part of LADCA was presented. Also, at the apex of the heart by 2D and color Doppler imaging 17mm long vessel was presented, termination into the right ventricle, with systolic flow which is reducing in the end systole according to the muscle contractility. (Figure 1.2).
CONCLUSION: We present a rare asymptomatic case of LADCA fistula into the apical part of the right ventricle. Basing on the position, diameter and decreasing flow during the myocardial contractility we decide to follow and to include bacterial endocarditis prevention.
KEY WORDS: congenital coronary cameral fistula, cardiac surgery, coronary artery, fistula, symptomatic, cardiovascular disease, cardiac catheterization
