Abstract
Coronary artery fistula is a connection between coronary artery and its branch to any of the cardiac chamber, great vessel or coronary sinus bypassing the myocardial capillary bed. Majority of fistulas are congenital in origin, although acquired fistulas may be encountered occasionally after cardiac surgery, endocarditis and after repeated myocardial biopsies (Somers and Verney, Clin Radioly 44:419–421, 1991). We report a 55-year-old female patient of large coronary cameral fistula between sinoatrial nodal artery and right atrium. She presented with congestive heart failure, atrial fibrillation and deterioration of left ventricular function with mitral regurgitation with functional class 3. The patient was managed with closure of origin of fistula from inside the aorta using polytetrafluoroethylene (PTFE) patch of 1.5 × 1.5 cm, on cardiopulmonary bypass using blood cardioplegia, as rest of the right coronary artery (RCA) was rudimentary. She had uneventful recovery with improvement in the functional class 1.
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