Accidental Left Circumflex Artery to Right Lung Fistula in a
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Introduction
The case reported herein was a 56-year-old woman with chronic excretion dyspnea (NYHA class II) since 20 years ago when she survived a pulmonary thromboembolism that was managed by the inferior vena cava filter and warfarin. Cardiac examination revealed an irregular rhythm with holosystolic murmur at left lateral sternal border. The physical examination was otherwise unremarkable. On ECG, rhythm was atrial fibrillation (74?bpm) and no significant ST-T changes. Transthoracic echocardiography showed a normal sized LV (LVEDD = 45?mm), no regional wall motion abnormality, moderate right ventricle (RV) enlargement with a right ventricular end diastolic dimension of 38?mm, and severe RV systolic dysfunction. There was also tricuspid annulus calcification with a severe tricuspid regurgitation and acceleration time of 89?msec and mean pulmonary artery pressure (PAP) was estimated to be 34?mmHg based on pulmonary valve systolic flow. RV papillary muscles were calcified....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124836/
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