Live three-dimensional transthoracic echocardiographic demonstration of septal perforator coronary artery-left ventricle fistulas following myectomy.

We present an adult patient with hypertrophic cardiomyopathy status post septal myectomy in whom live three-dimensional transthoracic echocardiography (3D TTE) demonstrated two septal perforator coronary arteries opening directly into the left-ventricular outflow tract. Only one of these fistulas could be demonstrated by two-dimensional transthoracic echocardiography (2D TTE). Our case demonstrates the potential usefulness of 3D TTE as a supplement to 2D TTE in the assessment of septal coronary artery-left ventricle fistulas.