Large common left and right coronary artery to coronary sinus fistula

Area of Science:

• Cardiology
• Vascular Surgery
• Congenital Heart Disease

Background:

• Coronary fistulas are rare vascular anomalies.
• They can lead to significant hemodynamic problems requiring intervention.
• This case presents a unique coronary fistula anatomy.

Purpose of the Study:

• To report the first described case of a coronary fistula originating from both the left and right coronary arteries.
• To discuss the implications of this rare anatomy on cardiac function.
• To highlight the indication for intervention in such cases.

Main Methods:

• Case report of a 47-year-old male patient.
• Detailed anatomical description of the coronary fistula.
• Assessment of cardiac function and ventricular dimensions.

Main Results:

• A large coronary fistula arising from both left and right coronary arteries was identified.
• The fistula drained into the coronary sinus and then the right atrium.
• Longstanding volume overload resulted in extreme dilation of coronary arteries and both ventricles.

Conclusions:

• This is the first reported case of a coronary fistula with this specific bilateral origin and drainage pattern.
• Significant ventricular dilation due to volume overload indicated surgical intervention, even in an asymptomatic patient.
• Management of complex coronary fistulas requires careful anatomical assessment and hemodynamic evaluation.