Chugh Y, Chugh S, Chugh S. The dilemma of evaluating a continuous murmur in a patient of aneurysm of sinus of Valsalva and coronary cameral fistula presenting with supraventricular tachycardia.
BMJ Case Rep 2015;
2015:bcr-2014-207197. [PMID:
25568273 DOI:
10.1136/bcr-2014-207197]
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Abstract
A 39-year-old hypothyroid woman on thyroxine replacement therapy presented with an unresolving episode of palpitations (narrow-complex tachycardia). Clinical examination, after reversion to normal sinus rhythm revealed a precordial continuous murmur. Initial transthoracic echocardiogram showed an unruptured aneurysm of left sinus of Valsalva (LSOV), however, because a continuous murmur could not be explained by this condition, a repeat colour Doppler study was made, revealing a communicating tract from the left main coronary artery (LMCA) and terminating in the right atrium (RA). A transesophageal echocardiogram revealed an aneurysmal LMCA and LSOV, with similar colour Doppler findings. A further CT scan and coronary angiogram confirmed a coronary cameral fistula opening into RA. In conclusion, the relevance of a diligent clinical examination and imaging after conversion to normal sinus rhythm in picking up such anomalies cannot be over-emphasised, as previous routine echocardiograms on the same patient had been reported as normal.
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