Combined apical hypertrophic cardiomyopathy and coronary artery-left ventricular fistula.

219 Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum offive references; onefigure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports ofunique educational charactet Specific permission to publish should be cited in a covering letter or appended as a postscript. Combined hypertrophic cardiomyopathy with coronary arterio-venous fistula is extremely rare. We report a unique patient who presented with apical hypertrophic cardiomyopathy associated with coronary artery-left ventricular fistula. A 50-year-old Chinese man was referred for evaluation of chest pain. Clinical examination revealed a blood pressure of 130/60 mm Hg. No murmur was heard in the precordium. Mild cardiomegaly was seen on chest x-ray film. The 12-lead electrocardiogram showed tall R waves in leads V2 and V3, and deep T wave inversion in the precordial leads, especially in leads V3 and V4. Two-dimensional echocardiography revealed apical hypertrophic cardiomyopathy. Left heart catheterization and selective coronary angiography was then performed.This showed bilateral coronary artery-left ventric-ular fistula and apical hypertrophic cardiomyopathy (Fig 1). Up to 1984, only three cases of combined hypertrophic cardio-myopathy with coronary arteriovenous fistula were reported in the FIGURE 1. Left coronary angiogram in the left anterior oblique position. All the branches of the left coronary artery system are dilated. There is streaming of dye into the left ventricle via a maze of fine vessels from these branches. LAD = left anterior descending artery. literature. Interestingly, in all three cases the coronary fistula communicated with the pulmonary artery. ' Apical hypertrophic cardiomyopathy is relatively uncommon in theWest but is frequent in Of all the coronary arteriovenous fistulae, coronary artery-left ventricular fistula is the rarest, seen in about 2 percent ofcases. As of 1981, only 23 cases ofcoronary artery-left ventricular fistulae have been reported.. However, the combination of apical hypertrophic cardiomyopathy and coronary artery-left ventricular fistula has not been previously described. coronary arteriovenous fistulas associated with idiopathic hyper-trophic cardiomyopathy. Am Heart nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy). Ventriculographic and echocardiographic features in 30 patients. We found the article by DeLorenzo et al' ofgreat interest. In this article, the radiologic manifestations of a group of patients with acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) were analyzed. Although the classic bilateral alveolar or interstitial patterns were …