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Real-time cross-sectional echocardiographic studies of the main coronary arteries were performed in 20 normal subjects, 12 patients with patent ductus arteriosus and 14 patients with coronary artery fistula in whom the diagnosis was established by angiography. In 12 patients, the coronary artery that formed the fistula was dilated: The right coronary artery was involved in eight and the left coronary artery in four. The dilated coronary artery appeared as two dominant parallel echoes of wide lumen originating from the aorta in the region of the involved artery. Th echo diameter of the coronary artery correlated well with the angiographically estimated diameter of the artery. In the normal subjects and the patients with patent ductus arteriosus, we found no echocardiographic findings of coronary artery dilatation. This study demonstrates that cross-sectional echocardiography is useful in identifying the dilated coronary artery in coronary artery fistula and distinguishing this entity from patent ductus arteriosus.

Noninvasive visualization of the dilated main coronary arteries in coronary artery fistulas by cross-sectional echocardiography.