LAUSR

A 56-year-old man presented with intermittent chest pain for 10 years. On physical examination, a grade 3/6 continuous murmur was audible on the right sternal border at the second and third intercostal spaces. Transthoracic echocardiography showed a dilated right subclavian artery (RSA) with a 5-mm fistula to the right innominate venous (RIV), in addition to a dilated right ventricle and right atrium and mild tricuspid regurgitation (Figure 1A and 1B, Videos 1 and 2). Continuouswave Doppler showed a flow signal at 5.4 m/s that was continuously moving from the RSA to the RIV throughout the cardiac cycle with a gradient of 116 mm Hg (Figure 1C). Maximum intensity projection (Figure 1D) and 3-dimensional reconstruction (Figure 1E, 1F) computed tomography angiography images showed an arteriovenous fistula from the RSA to the RIV associated with proximal stenosis and distal aneurysmal dilatation of the fistula vessels.