Left main coronary artery to right atrium fistula presenting with syncope: a case report
Mehak Gupta1, Andrew Cole1, Tom Butler1
1Department of Cardiology, University Hospitals of North Midlands NHS Foundation Trust, Stoke-on-Trent ST4 6QG, UK.
Insights
Coronary cameral fistula (CCF) is a rare anomaly. Transcatheter closure effectively treated a large CCF, resolving symptoms and demonstrating the value of multimodality imaging in diagnosis and planning.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary cameral fistula (CCF) represents a rare congenital coronary anomaly.
- While often asymptomatic, large CCFs can lead to significant cardiovascular complications such as myocardial ischemia, arrhythmias, and heart failure.
Background:
Coronary cameral fistula (CCF) is a rare coronary anomaly involving an abnormal communication between a coronary artery and a cardiac chamber or great vessel. While often asymptomatic, large fistulae may result in myocardial ischaemia, arrhythmias, or heart failure.
Case Summary:
A 38-year-old woman presented with palpitations, dizziness, and syncope. Clinical examination revealed a continuous murmur. Transthoracic echocardiography demonstrated right-sided chamber enlargement. Cardiac magnetic resonance imaging identified a large fistula originating from the left main coronary artery draining into the right atrium, with a Qp:Qs of 1.3. Cardiac computed tomography provided detailed anatomical delineation. Coronary angiography confirmed the diagnosis and demonstrated suitability for percutaneous intervention. Successful transcatheter closure was performed using a 10 mm Amplatzer Vascular Plug II, with immediate cessation of flow and subsequent symptom resolution.
Discussion:
This case highlights the diagnostic value of multimodality imaging in defining fistula anatomy, quantifying shunt burden, and guiding procedural planning. Transcatheter closure is a safe and effective treatment strategy for haemodynamically significant CCF.
Related Concept Videos
Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
Mitral Stenosis I: Introduction
Chambers of the Heart
Deoxygenated blood from the body is received in the right...
Cardiac Catheterization II: Right Heart Catheterization
Cardiac Catheterization III: Left Heart Catheterization
Mitral Stenosis II: Clinical features and Diagnostic Tests


