抄録
A 77-year-old woman was transferred to our hospital with pyelonephritis. A blood analysis showed a serum C-reactive protein level of 32 mg/dL and a plasma brain natriuretic peptide level of 531 pg/mL. A 12-lead electrocardiogram showed ST segment depression in the precordial leads, and a chest radiogram showed a cardiothoracic ratio of 62%. Transthoracic echocardiography revealed left ventricular hyperkinesis with an ejection fraction of 73%. Color Doppler imaging revealed mid-ventricular obstruction with isovolumic relaxation flow (IVRF) toward the base. The patient was then treated with antibiotics. Four days later, transthoracic echocardiography revealed resolution of the midventricular obstruction and IVRF. Furthermore, color Doppler demonstrated diastolic myocardial flow toward the apical lumen, which reversed toward the epicardium during early systole. Cardiac computed tomography showed no significant coronary artery stenosis. During early systole, the flow from the left ventricular lumen reversed to the coronary artery, confirming a coronary artery-to-left ventricle fistula. One year later, the patient was readmitted to our hospital with atrial fibrillation and heart failure. Neither coronary artery fistula nor midventricular obstruction was observed. This case demonstrates that a coronary artery-to-left ventricular fistula may transiently emerge under specific physiological or inflammatory conditions, such as mid-ventricular obstruction. Recognition of such dynamic changes is essential for understanding coronary-cameral fistulas and avoiding unnecessary intervention.
