Giant right coronary artery to coronary sinus fistula.

BACKGROUND

We describe a giant right coronary artery (RCA) to coronary sinus (CS) fistula in a 59-year-old woman who presented to our institution with right heart enlargement.

METHODS

Investigation revealed an ectatic 22mm RCA draining into an enlarged CS, and a Qp:Qs of 2.0. We proceeded with surgery. After initiating cardiopulmonary bypass and electrical arrest, the distal RCA was opened. An opening into the CS was confirmed and closed with a bovine pericardium patch. The RCA origin was triply ligated. Anastomoses of a saphenous vein graft to the posterior descending artery and the right ventricular marginal artery were performed, followed by anastomosis to the ascending aorta.

RESULTS

Post-operatively, mixed venous oxygen saturation was 76%. Six months later the patient was doing well.

CONCLUSION

Coronary artery fistulas are rare congenital anomalies for which the ideal management strategies remain under study, with surgical repair being the mainstay of treatment in complex, aneurysmal fistulas.