Rare Case of a Complex Coronary Triad Repaired via Axillary Thoracotomy in an Infant.

BACKGROUND

Coronary artery aneurysm (CAA) involving both the right coronary artery (RCA) and sinus node artery (SNA), with coronary artery fistulas draining into right atrium, is exceedingly rare, previously reported only in adults.

CASE SUMMARY: A 4-month-old female infant had abnormal right atrial flow on echocardiography. Computed tomography revealed giant RCA and SNA aneurysms, with dual fistulas into the right atrium. Surgical repair via right axillary thoracotomy included SNA occlusion testing, confirming sinus node function, and allowing ligation. Postoperative sinus node dysfunction resolved spontaneously, and the patient was discharged on day 6. One month later, she remained in sinus rhythm, with no residual fistula and favorable RCA aneurysm regression.

DISCUSSION: This triad is exceptionally rare in infants. Early surgery was indicated owing to aneurysm size and risk of shunt-related complications. Right axillary thoracotomy proved safe and effective.

TAKE-HOME MESSAGES: Coronary artery fistula with giant aneurysms justifies early surgery. Axillary thoracotomy safely addresses complex right coronary anomalies in infants.