Left circumflex coronary artery to left atrial fistula in a patient with mitral stenosis : invasive and noninvasive findings with pathophysiologic correlation

We report a case of an angiographically documented fistula between the circumflex coronary artery and a left atrial appendage thrombus in a patient with mitral stenosis, flow from which can be demonstrated solely by a color doppler transesophageal echocardiogram. Evaluation of catheter derived hemodynamics and angiographic flow patterns reveals a heretofore undescribed physiologic property of coronary to atrial shunts in patients with mitral stenosis. © 1996 Wiley-Liss, Inc.