Giant Right Coronary Artery Aneurysm Fistulization to the Coronary Sinus: Technique for Surgical Repair

Fistulas from the right coronary artery (RCA) to the coronary sinus (CS) are rare coronary anomalies, and their coexistence with diffuse RCA aneurysmal disease is even less common. We report a 76-year-old woman with severe symptomatic mitral regurgitation found to have a large, tortuous aneurysmal RCA draining through a large fistula into the CS. In patients with diffusely aneurysmal RCA anatomy, intracardiac closure from within the CS can avoid extensive epicardial dissection while preserving coronary venous drainage. Complex coronary anomalies should not preclude definitive valve and rhythm surgery when myocardial protection strategies are tailored to the underlying anatomy.