Abstract
BackgroundCongenital coronary artery fistula in association with aneurysm of the involved coronary artery in adults is rare. Moreover, the right coronary artery- left atrial fistula is also uncommon. Most of the cases are asymptomatic. However, symptomatic patients need therapeutic interventions. The potential complications associated with this anomaly are life-threatening, therefore, there is a need to explore more on differential diagnosis, investigations, management strategies and prevention of complications.Case presentationWe present herewith a 26-year-old male patient with symptoms of chest pain and dyspnea. He was diagnosed with aneurysmal dilatation of the right coronary artery in its entire course which terminated as a fistulous communication into the left atrium. The closure of the fistula was done using autologous pericardial patch under cardiopulmonary bypass. Currently, the patient is being followed up after surgery and receiving anticoagulants.ConclusionThe advancement in the diagnostic imaging modalities have made it possible to find similar abnormalities more frequently. Due to rare nature of this anomaly, there is a need to explore and discuss management strategies that include medical management, surgical intervention or percutaneous interventions for a successful outcome.
Highlights
Congenital coronary artery fistula in association with aneurysm of the involved coronary artery in adults is rare
The left atrium is involved in approximately 5% patients with coronary artery fistula (CAF) [1]
In view of recurrent chest discomfort, progressive dyspnea, cardiac enlargement, size of the involved coronary artery and location of the fistulous opening, the patient was considered for a surgical closure under standard cardiopulmonary bypass
Summary
The CAF in association with aneurysmal coronary artery can be managed successfully in adults. It requires differential diagnostic work-up, careful evaluation of fistula size, location and condition of the coronary arteries in order to select suitable therapy. Intracardiac surgical closure of the CAF is an appropriate option for the patients with late presentation, larger fistula and aneurysmal coronary arteries and those who are not amenable to transcatheter management. Author’s contributions All authors contributed either in the case management, literature search or preparation of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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