Coronary fistula of the left main artery draining in the right atrium and associated aorto-right atrial fistula

A 60 year old man was admitted to the E.R. for recurrence of transitory ischemic attacks. In order to exclude the presence of embolic sources a transesophageal echocardiography was performed which demonstrated an echo-free structure posteriorly to the aortic root, connected with the interatrial septum (Fig. 1 — A; online video 1). A continuous systo-diastolic flow inside the structure was evident at Color Doppler (Fig. 1 — B, online video 2), whereas the Continuous Doppler showed a high velocity systo-diastolic signal (>2.5 m/s; Fig. 1 — C) directed from the interatrial septum toward the right atrium.