The Multimodality Imaging for the Assessment of Giant Right Coronary
Artery Aneurysm with Fistula into the Right Atrium
Abstract
Background: Coronary artery fistula (CAF) is a congenital connection
between a coronary artery and cardiac chambers, or a vessel bypassing a
capillary system. The clinical presentation of congenital CAF varies,
depending on its size and the draining chamber. Case presentation: A
23-year-old patient without a prior medical history consulted to
cardiology clinic with a referral diagnosis of interatrial septal
aneurysm and defect. Transthoracic echocardiography revealed a dilated
right coronary artery to a sac into the right atrium with dilated right
side of the heart. Transesophageal echocardiography provided the
calculation of the narrowest part of the fistula where the closure
device was planned to be deployed, and two sequential sacs of the
fistula on its way to the right atrium. Cardiac computed tomography
demonstrated the aneurysmatic dilatation of the proximal portion of the
right coronary artery (CA) was 14*20 mm and the narrowest exit of the
CAF as 8*8.3 mm width. transcatheter closure of an isolated enormous CAF
was decided and surgery left to be reserved for CAF with failed
percutaneous closure. Conclusion: Multi-modality imaging take part in
the diagnosis and follow-up of the CAFs for identifying the
anatomy/physiology, guiding the intervention, supplementary hemodynamic
information, assessing the anatomical relationship and ischemia.