Right Coronary Artery-to-Right Atrial Fistula Accompanied by Multiple Right Coronary Artery Aneurysms: A Case Report
Kevin Watat1, Georgette Nader2,1, Rand Sabanci1
1Internal Medicine, Michigan State University, East Lansing, USA.
Insights
This case study highlights a patient with a right coronary artery-to-right atrial fistula and aneurysms. Management focused on atrial fibrillation, with ongoing monitoring for fistula and aneurysm progression.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysms (CAA) involve localized arterial dilation.
- Coronary artery fistulas are abnormal connections between coronary arteries and cardiac chambers/vessels.
Observation:
- A 68-year-old female presented with a right coronary artery-to-right atrial fistula and multiple right coronary artery aneurysms.
- Initially asymptomatic, the patient developed atrial fibrillation, managed with metoprolol tartrate and cardioversion.
Findings:
- The patient's fistula remained stable initially, with no immediate need for intervention.
- Subsequent imaging revealed progressive fistula expansion and new coronary artery aneurysms.
Implications:
- This case underscores the complex management of combined coronary artery fistulas and aneurysms.
- Ongoing surveillance is crucial to determine optimal timing for interventional strategies in progressive disease.
Abstract:
A coronary artery aneurysm (CAA) denotes a localized dilation of the coronary artery, while a coronary artery fistula signifies an aberrant connection between a coronary artery and a cardiac chamber or adjacent vessel. Here, we present a case study of a 68-year-old female with a previously diagnosed right coronary artery-to-right atrial fistula concomitant with multiple right coronary artery aneurysms. Initially asymptomatic, the patient subsequently manifested atrial fibrillation. Management involved augmenting the patient's home regimen with metoprolol tartrate, followed by successful cardioversion and restoration of sinus rhythm. Given the stability of the fistula and the absence of symptomatic exacerbation, no further interventional measures were undertaken. The patient was discharged with an adjusted metoprolol regimen and scheduled follow-up with her cardiologist. Subsequent imaging assessments unveiled progressive fistula expansion alongside the development of concurrent CAA, inciting deliberations concerning optimal treatment modalities.
