Tortuous right coronary artery to coronary sinus fistula

Abstract

We are reporting the successful surgical treatment of a 23-year-old female with a giant right coronary artery to coronary sinus fistula. This woman had complaints of chest pain and dyspnea on exertion for few months. Transthoracic echocardiography (TTE) showed a large tortuous right coronary artery and a dilated coronary sinus. Preoperative multi-detector computed tomography (MDCT) coronary angiography and cardiac catheterization confirmed the diagnosis of a right coronary artery to coronary sinus fistula. The patient underwent surgical closure of the fistula and division of the communication between the right coronary artery and the coronary sinus with the use of cardiopulmonary bypass. The patient was discharged home on postoperative day 5 and at one-year follow-up is symptom-free.

Evaluation of patients with coronary artery anomalies

“…[20] With the recent developments, ECG-gated multi-detector computed tomography angiography (MDCT) also provides non-invasive diagnosis in coronary artery diseases and malformations. [8] It is believed that non-invasive techniques can replace conventional angiography for the definitive diagnosis. [21] All of the patients in group 2 showed the diagnostic findings with TTE.…”

“…Vascular plugs, umbrella devices, and covered stents are also used. [3,7,8] The main limitations of the transcatheter approach, however, are inability to deliver the catheter to the fistula due to excessive tortuosity, inadequate size of the coronary artery, and presence of coronary branches at the site of the CAF, which occur in nearly 15% of cases. [24] The Amplatzer PDA occluders have several advantages over other devices to close CAFs, including the use of a single device, a high rate of complete occlusion, and improved control over placement and release of the device.…”

“…[7] The majority of the cases are asymptomatic; however, with exercise, symptoms such as chest pain, dyspnea, and syncope can be manifested. [7][8][9][10] In CAFs, clinical symptoms and the age of onset are associated with the underlying anatomy and the diameter of the fistula. [8] When calibration of the fistula is small, clinical findings may not be evident.…”

“…[7][8][9][10] In CAFs, clinical symptoms and the age of onset are associated with the underlying anatomy and the diameter of the fistula. [8] When calibration of the fistula is small, clinical findings may not be evident. If the diameter of the fistula is large, mitral and tricuspid regurgitation, heart failure, myocardial ischemia, infarct, bacterial endocarditis, rupture and premature arteriosclerosis may be present.…”

“…If the diameter of the fistula is large, mitral and tricuspid regurgitation, heart failure, myocardial ischemia, infarct, bacterial endocarditis, rupture and premature arteriosclerosis may be present. [3,8] The aforementioned clinical findings and complications can be avoided with early closure of the fistula. In addition, fistulas may originate from the right coronary artery (RCA) (50%), left main coronary artery (LMCA) (42%) or both (5%) based on their frequencies.…”