Coronary artery fistula between the left circumflex artery and right atrium

Excerpt

Coronary artery fistulas (CAF) are rare coronary artery anomalies that originate from the coronary artery and drain into any cardiac chamber and great vessel. The occurrence rate is around 0.002% in the general population [1]. In this report, a 49-year-old woman with a complaint of palpitations and dyspnea for more than 1 year was referred to this hospital. Transthoracic echocardiography showed the left circumflex (LCX) coronary artery had an opening diameter of 1.93 cm (Fig. 1a). Doppler imaging detected an apparently dilated LCX, which entered the right atrium (RA) with a turbulent shunt in the fistula (442 cm/s, 78 mm Hg; Fig. 1b and c). A chest x‑ray image showed a notable enlargement of the heart (Fig. 1d). The computed tomography angiography (CTA) images showed an enlarged left main (LM) coronary artery at the left coronary sinus. The LM was continued with a dilated LCX (Fig. 1e–g, video 1 and 2). Coronary angiography failed to seal the fistula with cardiovascular intervention since the fistula course was too tortuous (Fig. 1h, video 3 and 4). Surgical treatment was advised to the patient. The CAF was identified and ligated inside the right atrium. Postoperative CTA showed the blockage of LCX and no shunt (Fig. 1i).

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