Prenatal diagnosis of isolated coronary arteriovenous fistul
Coronary arteriovenous fistula (CAVF) is defined as an abnormal fistulous connection between a coronary artery and any of the 4 chambers. Published in the journal Obstet Gynecol Sci, the authors describe a case wherein a fistula between the left coronary artery and coronary sinus by prenatal echocardiography was successfully diagnosed. This is the first report of a prenatally diagnosed fistula between the left coronary artery and coronary sinus.

A 23-year-old woman, gravida 1, para 0, was referred for a detailed cardiovascular evaluation for hypoplastic left heart syndrome at 25.3 weeks of gestation. Her medical and family histories were unremarkable.

Initial fetal echocardiography demonstrated situs solitus with atrioventricular and ventricular arterial concordance. A 4-chamber view of the heart revealed mild dilatation of the right atrium and right ventricle without tricuspid regurgitation. In the 5-chamber view, the left coronary artery was dilated and directly connected to the coronary sinus.

Power Doppler sonography confirmed the presence of the fistula between the left coronary artery and coronary sinus; thus, the diagnosis of a CAVF was made. A relatively small aorta was observed after branching of the left coronary artery without any obstruction signs, and color Doppler showed reversal flows in the ascending aorta and aortic arch during the diastolic phase. No other abnormalities were detected, and the parent refused fetal karyotyping.

Key takeaways:-
- Herein, the authors report an extremely rare case of abnormal vascular connections involving the left circumflex coronary artery and coronary sinus.

- A careful echocardiographic examination in the prenatal period is applicable for the diagnosis of a CAVF and aids its timely management.

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