Left main coronary artery to right atrium fistula presenting with syncope: a case report.

BACKGROUND

Coronary cameral fistula (CCF) is a rare coronary anomaly involving an abnormal communication between a coronary artery and a cardiac chamber or great vessel. While often asymptomatic, large fistulae may result in myocardial ischaemia, arrhythmias, or heart failure.

CASE SUMMARY: A 38-year-old woman presented with palpitations, dizziness, and syncope. Clinical examination revealed a continuous murmur. Transthoracic echocardiography demonstrated right-sided chamber enlargement. Cardiac magnetic resonance imaging identified a large fistula originating from the left main coronary artery draining into the right atrium, with a Qp:Qs of 1.3. Cardiac computed tomography provided detailed anatomical delineation. Coronary angiography confirmed the diagnosis and demonstrated suitability for percutaneous intervention. Successful transcatheter closure was performed using a 10 mm Amplatzer Vascular Plug II, with immediate cessation of flow and subsequent symptom resolution.

DISCUSSION: This case highlights the diagnostic value of multimodality imaging in defining fistula anatomy, quantifying shunt burden, and guiding procedural planning. Transcatheter closure is a safe and effective treatment strategy for haemodynamically significant CCF.