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Asian Cardiovasc Thorac Ann 2003;11:96
© 2003 Asia Publishing EXchange Ltd

LETTER TO THE EDITOR

Transesophageal Echocardiography for Pulmonary Artery to Left Atrial Fistula

Kavassery Mahadevan Krishnamoorthy, DM, Sekhar Rao, MCh1

Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India
1 Department of Cardiac Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, India

The report of a rare case of right pulmonary artery (PA) to left atrial (LA) fistula by Faizal and colleagues1 is very interesting. The authors performed transthoracic echocardiography with contrast injection in a peripheral vein. According to them, immediate and dense opacification of the left atrium suggested a PA–LA fistula. In our experience, transesophageal echocardiography (TEE) gives a complete and better picture of the condition,2 highlighted in the case below.

Transthoracic echocardiography in a 19-year-old cyanotic patient showed color flow into the left atrium, while TEE showed a vessel arising from the right PA and entering the left atrium, with color flow in that direction (Figure 1Go). We were therefore able to make a noninvasive diagnosis of type I PA–LA fistula. There were no other intracardiac lesions. The patient underwent successful simple ligation of the fistula.



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  		Figure 1. Color flow mapping on transesophageal echocardiogram showing drainage of the right pulmonary artery (RPA) into the left atrium (LA).

 
We would like to emphasize that PA–LA fistulas can be easily diagnosed by TEE and that it does not suggest but confirm the diagnosis. More invasive techniques are required only if the diagnosis cannot be established by TEE.

Acknowledgments

We thank Elsevier Science, Oxford, for permission to reproduce Figure 1Go and data from Krishnamoorthy KM, Rao S. Pulmonary artery to left atrial fistula. Eur J Cardio-thorac Surg 2001;20:1052–3.

REFERENCES

  1. Faizal A, Madhu Sankar N, Murthy KS, Cherian KM. Right pulmonary artery-to-left atrial fistula. Asian Cardiovasc Thorac Ann 2002;10:80–2.[Abstract/Free Full Text]

  2. Krishnamoorthy KM, Rao S. Pulmonary artery to left atrial fistula. Eur J Cardio-thorac Surg 2001;20:1052–3.[Abstract/Free Full Text]





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