Right Coronary Artery to Right Atrial Fistula: Role of Multi-Modality Imaging and Percutaneous Closure

Area of Science:

• Cardiology
• Cardiac Surgery
• Vascular Medicine

Background:

• Coronary artery fistula (CAF) is a rare congenital or acquired cardiovascular anomaly.
• CAFs represent abnormal connections between the coronary arteries and cardiac chambers or great vessels.
• Clinical presentation varies widely, from asymptomatic to severe heart failure.

Observation:

• A case of a coronary artery fistula originating from the right coronary artery and draining into the right atrium is presented.
• The patient's primary clinical manifestation was atrial fibrillation, mimicking other common cardiac conditions.
• This specific fistula anatomy and its presenting arrhythmia are noteworthy.

Findings:

• The fistula was successfully identified as the source of the patient's symptoms.
• Diagnostic imaging confirmed the right coronary artery to right atrium connection.
• The atrial fibrillation was attributed to the hemodynamic changes induced by the fistula.

Implications:

• This case underscores the importance of considering CAF in the differential diagnosis of arrhythmias, particularly atrial fibrillation.
• Successful management of CAF can resolve associated arrhythmias and improve cardiac function.
• Both surgical and percutaneous closure techniques offer viable options for treating coronary artery fistulas.