Ped Cardiol 2:145-149, 1982 Pediatric Cardiology Pulsed Doppler Echocardiographic Detection of Coronary Artery to Right Ventricle Fistula Arthur S. Pickoff, Grace S. Wolff, Vicki L. Bennett, Gerard Kaiser, Pedro L. Ferrer bepartment of Pediatrics, University of Miami, School of Medicine, Miami, Florida SUMMARY. The pulsed Doppler echocardiographic (PDE) findings in a case of coronary artery right ventricle fistula are described. The PDE examination revealed normal flow patterns within the right atrium, pulmonary artery, and left ventricle, thus excluding these structures as the distal site of the fistula. Sampling within the right ventricular inflow revealed a turbulent, continuous, systolic-diastolic flow pattern that suggested the right ventricle was the distal end of the fistula. Postoperatively, the PDE examination of the right ventricle reverted to a normal, nonturbulent, phasic flow pattern. We conclude that PDE may he a useful noninvasive method of defining the site of drainage in cases of coronary artery fistula. KEy WORDS: Congenital heart disease -- Doppler eehocardiography m Coronary eameral fiStula Pulsed Doppler echocardiography (PDE) is a form of diagnostic ultrasound that permits a description of the direction (toward or away from the examining transducer) and character (turbulent vs nonturbu- lent) of blood flow within the chambers of the heart and great vessels. This information is contained Within an electronic display (the time interval histo- gram) of the change in frequency shift of an incident Ultrasound signal, as that signal is reflected from moving RBCs (ie, the Doppler frequency shift) [I]. Net flow toward the transducer is indicated by a Positive deflection of the time interval histogram, While net flow away from the transducer is indicat- ed by a negative deflection. Second, the character of the blood flow (turbulent vs nonturbulent) can be assessed. Turbulent blood flow is registered as a dispersion of the dots comprising the time interval histogram. While performing the PDE examination, turbulence is also readily detected by the examiner SupPorted in part by grants HL 07436 and HL00881 from the ~sational Institutes of Health Address reprint requests to: Arthur S. Pickoff, M.D., Pediatric Cardiology, Department of Pediatrics, University of Miami, School of Medicine, PO Box 016820, Miami, FL 33101 as a change in the character (harshness) of the audio representation of the flow pattern. Using this tech- nique in the pediatric patient, it has been possible to diagnose left-to-right shunts at the ductal [7], atrial [2], and ventricular levels [8], as well as to diagnose and describe the sites of drainage in cases of total anomalous pulmonary venous return [5, 6, 10]. In the following report, the preoperative and postoperative PDE findings are presented in a cath- eterization-proved case of coronary artery fistula to the right ventricle. The abnormal flow pattern de- tected and localized to the right ventricle, which disappeared postoperatively, represents an impor- tant diagnostic feature of this lesion and should be sought in patients in whom this lesion is clinically suspected. Case Report A 2-year-old girl was referred with a diagnosis of patent ductus arteriosus. She had been in good health all her life, without significant illnesses or hospitalizations. Her growth and develop- ment had been normal. She was born in Greece by normal 0172-0643/82/0002-0145 $01.00 9 1982 Springer-Verlag New York Inc.