case_images: PMC5025422_01
case_images: Right coronary artery-right ventricle (RV) fistula. a
  Arrow showed the dilated right coronary artery. b
  Arrow showed the aneurismal dilatation of right coronary artery. c
  Arrow showed fistula ostium. d The spectrum of fistula was continuous. Ao aorta, LA left atrium, LV left ventricle, RA right atrium, RV right ventricle
case_images: 40064_2016_3276_Fig1_HTML.jpg
case_images: PMC5025422_01_40064_2016_3276_Fig1_HTML.jpg
case_images: Fig1
case_images: TTE revealed that the right coronary artery (RCA), of which diameter was significantly increased (7.9 mm), coursed to right about 25 mm (Fig. 1a, arrow). In this aneurysm, blood flow like a whirlpool (Fig. 1b, arrow). The blood flow through a fistula ostium, which was on the aneurysm wall, into the right ventricle (Fig. 1c, arrow). The peak velocity of blood flow is 3.5 m/s in the diastole (Fig. 1d).
case_images: PMC5025422_02
case_images: Left anterior descending-pulmonary artery fistula. a
  Arrow showed the abnormal blood flow in the pulmonary artery. b
  Arrow showed the origin of the fistula is left anterior descending. c The spectrum of fistula showed only in diastole
case_images: 40064_2016_3276_Fig2_HTML.jpg
case_images: PMC5025422_03_40064_2016_3276_Fig2_HTML.jpg
case_images: Fig2
case_images: Track the blood flow, we found that the coronary artery opened at the right atrium and the spectrum of fistula was continuous (Fig. 2b-d). At the same time, mild pulmonary stenosis and a big atrial septal defect also have been detected (Fig. 2c, arrow). Angiography confirmed the diagnosis (Fig. 2e). One week after surgery, another TTE was performed and found that a residual flow on the top of right atrium (Fig. 2f, arrow).
case_images: PMC5025422_03
case_images: Left anterior descending-pulmonary artery fistula. a
  Arrow showed the abnormal blood flow in the pulmonary artery. b
  Arrow showed the origin of the fistula is left anterior descending. c The spectrum of fistula showed only in diastole
case_images: 40064_2016_3276_Fig2_HTML.jpg
case_images: PMC5025422_03_40064_2016_3276_Fig2_HTML.jpg
case_images: Fig2
case_images: Track the blood flow, we found that the coronary artery opened at the right atrium and the spectrum of fistula was continuous (Fig. 2b-d). At the same time, mild pulmonary stenosis and a big atrial septal defect also have been detected (Fig. 2c, arrow). Angiography confirmed the diagnosis (Fig. 2e). One week after surgery, another TTE was performed and found that a residual flow on the top of right atrium (Fig. 2f, arrow).
case_images: Right coronary artery-right atrium (RA) fistula. a
  Arrow showed the dilated right coronary artery. b
  Arrow showed the course of fistula. c
  White arrow showed fistula ostium, black arrow showed the atrial septal defect. d The spectrum of fistula is continuous. e Angiography confirmed the diagnosis before surgery. f
  Arrow showed a tiny residual shunting after surgery. Ao aorta, LV left ventricle, RA right atrium, RV right ventricle
case_images: 40064_2016_3276_Fig3_HTML.jpg
case_images: PMC5025422_03_40064_2016_3276_Fig3_HTML.jpg
case_images: Fig3
case_images: TTE revealed that the diameter of RCA was significantly increased (9.0 mm) (Fig. 3a, arrow).
case_images: PMC5025422_04
case_images: Left anterior descending-left ventricle (LV) fistula. a
  Arrow showed the dilated left anterior descending. b Color Doppler showed the course of fistula. c
  Arrow showed fistula ostium. d The spectrum of fistula showed only in diastole. e Surgery confirmed the diagnosis. f Arrow showed a tiny residual shunting after surgery. Ao aorta, LA left atrium, LV left ventricle, RA right atrium, RV right ventricle
case_images: 40064_2016_3276_Fig4_HTML.jpg
case_images: PMC5025422_04_40064_2016_3276_Fig4_HTML.jpg
case_images: Fig4
case_images: TTE showed LAD was dilated (12 mm) (Fig. 4a, arrow). The fistula ostium was on the middle part of ventricular septum (Fig. 4c), and its size was 5 mm. The spectrum of fistula revealed the shunt mainly occurred in diastole and peak speed was more than 4.0 m/s (Fig. 4d). Intraoperative findings confirmed the TTE diagnosis (Fig. 4e). TTE was performed and found there was a residual flow (Fig. 4f, arrow).
case_images: PMC5025422_05
case_images: Left circumflex (LCX)-coronary sinus (CS) fistula. a LCX was dilated and connected with CS. b CS was connected with right atrium (RA). CS coronary sinus, LCX left circumflex, LV left ventricle, RA right atrium, RV right ventricle
case_images: 40064_2016_3276_Fig5_HTML.jpg
case_images: PMC5025422_05_40064_2016_3276_Fig5_HTML.jpg
case_images: Fig5
case_images: TTE showed coronary artery fistula from the left circumflex to coronary sinus (Fig. 5).