Coronary Cameral Fistula Disclosed by Echocardiography: A Case Report of Typical Findings and Literature Review

Background: Coronary cameral fistula is a rare cardiovascular anomaly, and usually needs advanced image modalities, such as computerized tomography and/or angiography, to confirm its existence. A few reports in the literature have addressed the role of medical ultrasound in the diagnosis of this disease, without a comprehensive summary of all the valuable echocardiographic features in its diagnosis.

Case Presentation: Hereby, we presented an 80-year-old lady with exertional dyspnea and angina. We diagnosed coronary cameral fistula from the left anterior descending artery into the left ventricle by echocardiography with “intramyocardial vascular channel and the diastolic flow”, and “multiple diastolic flow jets into heart chamber from heart wall”. We confirmed the diagnosis with coronary angiography later. In the discussion, we make a comprehensive summary to conclude all the echocardiographic findings of this disease into 3 categories.

Conclusion: We believe the identification of those findings will prompt the early diagnosis of this rare anomaly.

Current Pharmacologic Management of Pediatric Heart Failure in Congenital Heart Disease

Pharmacologic therapy represents the mainstay of treatment for heart failure in children. However, medical therapy for this population is not widely standardized. This is mainly due to the heterogeneity of potential etiologies, the specific challenge of patients with univentricular physiology and the lack of evidence-based prospective randomized clinical trials in pediatric patients. In fact, most current strategies are based largely on extrapolated data from adult studies. Although the classic drugs for heart failure i.e. diuretics, angiotensin-converting enzyme inhibitors, β-blockers and cardiac glycosides, still play a major role in the treatment of pediatric heart failure, newer alternative therapies such as levosimendan and nesiritide are increasingly utilized with promising early results. A systematic literature search of PubMed and MEDLINE databases using relevant terms was performed. All clinical trials and relevant manuscripts about the current pharmacologic treatment of heart failure in the pediatric population were reviewed. New drugs such as levosimendan and nesiritide and the treatment of single-ventricle patients were also included.

Cor Triatriatum

Coronary Cameral Fistula Disclosed by Echocardiography: A Case Report of Typical Findings and Literature Review

Current Pharmacologic Management of Pediatric Heart Failure in Congenital Heart Disease