A 36-year-old woman was referred because of a continuous cardiac murmur. Standard transthoracic two-dimensional echocardiography was normal. Using the transverse plane of biplane transesophageal echocardiography (TEE) a distinct dilatation of the proximal portion of the right coronary artery could be visualized. Morphology and the information from color-coded Doppler echocardiography were consistent with a coronary artery fistula. However, the exact course of the fistula and its drainage could not be seen. Only by using the longitudinal plane of biplane TEE its site of drainage into the vena cava superior could be demonstrated morphologically, as well as by color-coded Doppler imaging.

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