Multiple Fistulae Connecting the Right Coronary Artery to the Coronary Sinus

Abstract

Right coronary artery to coronary sinus fistula is a rare anomaly. We present a unique case of an adult patient with multiple fistulae from the right coronary artery draining into the coronary sinus near the posterior left atrium-left ventricle junction, first suspected by transthoracic two-dimensional echocardiography. The multiple openings were not seen by any invasive or noninvasive techniques and were noted only at the time of surgery. To our knowledge, this is the first case of multiple fistulae connecting the right coronary artery to the coronary sinus that has been reported in the English literature.

The Utility of Live Three‐Dimensional Echocardiography in the Surgical Treatment of Bilateral Coronary Fistulas

“…However, drainage sites may be difficult to identify if there are multiple right ventricular or pulmonary arterial connections. Two‐dimensional TEE with color Doppler imaging did not reveal an abnormal jet in the fistula because the flow was perpendicular to the ultrasound beam 5 . Therefore, 2D TEE did not clearly define the drainage sites.…”

Right Coronary Artery Hepatic Vein Fistula: A Case Report

“…The fistulas may drain from the right or left coronary artery into the RV (41%), RA (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%), or the superior vena cava (1%) 7 . Multiple fistulas have also been reported 2,3 . However, a coronary fistula that drains into a hepatic vein has not been reported in the literature to date.…”

“…An association of right coronary artery fistulas with ASD, 10 and patent foramen ovale has been observed, 3 but these fistulas drained into the coronary sinus rather than the hepatic vein. Our patient had a secundum ASD which was of restrictive origin.…”

“…Coronary artery fistulas have often been described and can be congenital or acquired. There is a slight predominance for coronary artery fistulas that involve the right coronary artery, 1 while multiple fistulas have also been reported 2,3 . The usual site of termination is one or more low‐pressure structures in the heart or the great vessels such as the right or left atria, right ventricle (RV), coronary sinus, pulmonary artery, or superior vena cava 1,4 .…”

Multiple Coronary Artery Fistulae Communicating through a Sinusoid and Emptying into the Left Ventricle

“…Congenital and acquired arterial venous fistulae have been described previously 3–5 . The majority is systemic fistulae.…”