Because coronary AV fistula usually contains conglomerated vessels as in our case, the direction of color Doppler flow could be opposite to shunt direction depending on the position and angle of the probe. Based on this fact, every effort had been made to detect the color Doppler flow toward the main pulmonary trunk, but we could not find any flow draining into the pulmonary trunk. Therefore, the fact that direction of Doppler

color flow is away from the main pulmonary trunk cannot exclude the possibility of the presence of congenital coronary AV fistula. On the contrary, detection of abnormal Doppler flow during diastole regardless of flow direction should be followed by suspicion of the presence of coronary AV fistula. Despite Inhibitors,research,lifescience,medical many reports till now, management of coronary AV fistula patients has still not been clearly defined. Generally, symptomatic coronary AV fistula is check details managed with surgical ligation or occlusion by interventional Inhibitors,research,lifescience,medical catheterization.16),17) Antiplatelet therapy, such as low-dose aspirin, is recommended and prophylactic precautions for subacute bacterial endocarditis are also recommended.8) If the patient is asymptomatic, measurement Inhibitors,research,lifescience,medical of shunt ratio (Qp/Qs) by cardiac catheterization has clinical importance especially in children because frequency of symptoms increases as patients are getting older.14) However data are lacking concerning the treatment of incidentally-found

and asymptomatic coronary AV fistula in adults. Therefore, decision to perform surgical ligation or interventional occlusion should be made case-by-case. We believe that asymptomatic, old patient without aneurismal dilation of the coronary artery

can be safely managed without surgical or Inhibitors,research,lifescience,medical interventional treatment, as in our case. In conclusion, we report here a rare case showing a conal branch of the right coronary artery-to-main pulmonary trunk fistula detected by chance on TTE in an asymptomatic, old patient.

There were 121 patients who had ASM, resulting in an overall incidence of 73%. There were no statistically significant Inhibitors,research,lifescience,medical differences between the 2 groups regarding any of the baseline characteristics (Table 1). Table 1 Baseline characteristics and type of very surgery of the patients There were no significant differences in preoperative and postoperative echocardiographic parameters between groups, but patients in the ASM+ group had lower ejection fraction (63.1 ± 6.7% vs. 64.9 ± 6.8%; p = 0.031) (Table 2 and ​and33). Table 2 Pre and post-operative echocardiographic parameters Table 3 Pre and post-operative circumferential strain analysis Strain analysis using velocity vector images Neither global nor regional CSs presented changes in patients in the ASM+ or in the ASM-groups, but systolic VRad of the antero-septum and anterior wall significantly decreased after surgery in patients in the ASM+ group (ΔVRad of the antero-septum: 0.6 ± 1.9 vs. 0.1 ± 1.2; p = 0.035 and anterior wall: 1.1 ± 1.9 vs. 0.