A circumflex coronary artery-to-right atrial fistula in a 10-month-old child

Area of Science:

• Cardiology
• Congenital Heart Disease
• Pediatric Cardiology

Background:

• Coronary fistulas (CFs) are rare congenital anomalies connecting coronary arteries to heart chambers or great vessels.
• In children, CFs are often asymptomatic, but symptomatic cases require management.
• The circumflex artery (Cx) is an uncommon source, and the right atrium is a frequent drainage site for pediatric CFs.

Observation:

• A 10-month-old boy presented with symptoms and an incidentally detected atrial septal defect (ASD).
• A coronary fistula (CF) originating from the circumflex artery (Cx) and draining into the right atrium was identified.
• The patient's symptomatic presentation and small size precluded percutaneous closure of the ASD.

Findings:

• The study details a rare case of a symptomatic pediatric patient with a Cx-to-right atrium fistula.
• The co-existing atrial septal defect (ASD) contributed to the clinical presentation.
• Surgical intervention was chosen for simultaneous closure of both the ASD and the CF.

Implications:

• This case highlights the importance of diagnosing rare coronary artery anomalies in symptomatic infants with congenital heart defects.
• Surgical management can be effective for complex cases involving both CF and ASD in pediatric patients.
• Understanding the varied presentations of coronary fistulas is crucial for appropriate pediatric cardiac care.