Congenital aneurysmal right coronary artery with a fistula to the left atrium in an adult

• Published in: Journal of cardiothoracic surgery Vol. 14; no. 1; p. 33
• Main Authors: Jha, Neerod Kumar, Kiraly, Laszlo, Shah, Nishant, Al Mulla, Arif, Mora, Bassem
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.02.2019; BioMed Central; BMC
• Subjects: Abnormalities; Adults; Aneurysm; Anticoagulants; Artery; Atrium; Cardiac; Case Report; Chest pain; Complications; Coronary; Coronary artery; Coronary artery bypass; Coronary vessels; Diagnostic imaging; Diagnostic systems; Differential diagnosis; Dyspnea; Electrocardiography; Fistula; Fistulae; Fistulas; Genetic disorders; Health aspects; Heart failure; Heart surgery; Management; Medical imaging; Pain; Patients; Prevention; Pulmonary arteries; Respiration; Signs and symptoms; Strategic planning (Business); Surgery; Therapeutic applications; Vascular fistula; Veins & arteries; Intervention; Atrium; Percutaneous; Cardiac; Surgery; Aneurysm; Coronary; Fistula; Artery
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-019-0854-6

Congenital coronary artery fistula in association with aneurysm of the involved coronary artery in adults is rare. Moreover, the right coronary artery- left atrial fistula is also uncommon. Most of the cases are asymptomatic. However, symptomatic patients need therapeutic interventions. The potential complications associated with this anomaly are life-threatening, therefore, there is a need to explore more on differential diagnosis, investigations, management strategies and prevention of complications. We present herewith a 26-year-old male patient with symptoms of chest pain and dyspnea. He was diagnosed with aneurysmal dilatation of the right coronary artery in its entire course which terminated as a fistulous communication into the left atrium. The closure of the fistula was done using autologous pericardial patch under cardiopulmonary bypass. Currently, the patient is being followed up after surgery and receiving anticoagulants. The advancement in the diagnostic imaging modalities have made it possible to find similar abnormalities more frequently. Due to rare nature of this anomaly, there is a need to explore and discuss management strategies that include medical management, surgical intervention or percutaneous interventions for a successful outcome.