Giant left circumflex coronary artery aneurysm with fistula to the right atrium

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Coronary artery fistulae (CAF) are uncommon congenital or acquired abnormal connections between a coronary artery and a heart chamber or great vessel.
• Prevalence is approximately 0.2% in patients undergoing coronary angiography, with most originating from the right coronary artery.
• While often asymptomatic, CAFs can lead to significant complications such as angina, heart failure, and arrhythmias.

Observation:

• We report a rare case of a patient with a significantly dilated circumflex coronary artery.
• The circumflex artery exhibited two giant aneurysms.
• A fistulous tract directly connected the aneurysms to the right atrium.

Findings:

• This unusual anatomy presented a unique challenge for diagnosis and potential management.
• The large aneurysms and direct right atrial communication represent a rare variant of coronary artery fistula.
• Detailed imaging was crucial for delineating the complex fistulous pathways.

Implications:

• This case underscores the importance of recognizing diverse presentations of coronary artery anomalies.
• Understanding such rare anatomies is vital for surgical planning and patient outcomes.
• Further research into the natural history and management of giant coronary aneurysms with fistulae is warranted.