Multiple fistulae connecting the right coronary artery to the coronary sinus

Area of Science:

• Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Coronary artery fistulae are uncommon congenital or acquired cardiovascular abnormalities.
• Right coronary artery (RCA) to coronary sinus (CS) fistulae represent a specific subtype, rarely reported.
• Diagnosis and characterization of complex fistulous tracts can be challenging.

Observation:

• A unique case of multiple RCAs draining into the CS near the posterior left atrium-left ventricle junction is presented.
• Transthoracic two-dimensional echocardiography initially suspected the anomaly.
• Surgical visualization was required to identify the multiple distinct fistulous openings, which were not detected by prior noninvasive or invasive imaging.

Findings:

• This report details the first documented instance of multiple RCAs directly connecting to the CS in the English literature.
• The complex anatomy involved multiple fistulous tracts, deviating from typical single-orifice fistulae.
• Surgical findings confirmed the extensive nature of the anomaly.

Implications:

• Highlights the potential for echocardiography to suggest complex coronary artery anomalies.
• Underscores the limitations of conventional imaging in fully delineating multiple fistulae.
• Emphasizes the importance of surgical exploration for definitive diagnosis and management planning of rare cardiac malformations.