Coronary aneurysm accompanied by a coronary artery fistula and atrial septal defect

A 56-year-old female patient was admitted to our clinic with complaint of dyspnea on exertion with progressive worsening of the functional class in last months. Electrocardiography showed Atrial Fibrillation (AF) and Transthoracic Echocardiography (TTE) showed normal Left Ventricular (LV) systolic function with grade 3 tricuspide and grade 2 mitral insufficiency. Pulmonary arterial pressure was 45 mmHg and Right Atrium (RA) and right ventricle were dilated. Selective coronary angiography was performed. There was no obvious lesion on coronary arteries and their branches, except that the Right Coronary Artery (RCA) was dilated and tortuous and had an aneurysm. Multidetector computed tomography showed significantly dilated and tortuous RCA which significantly broadened distally and opened into the RA. Under cardiopulmonary bypass, right atriotomy was performed and an Atrial Septal Defect (ASD) revealed. This defect was closed and repaired primarily. Fistula ostium was seen from coronary sinus. Primary repair from coronary sinus window was performed. Severe regurgitation of tricuspid valve was observed and De Vega anuloplasty was performed. © 2013 Indian Association of Cardiovascular-Thoracic Surgeons.