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Accidental finding of a giant right coronary artery aneurysm associated with a fistula to the right atrium

Published online by Cambridge University Press:  22 May 2013

Patrícia Vaz Silva ,
Joana Castro Marinho  and
António Pires
Patrícia Vaz Silva*
Affiliation:
Pediatric Cardiology Department, Pediatric Hospital Carmona da Mota, CHUC EPE, Coimbra, Portugal
Joana Castro Marinho
Affiliation:
Pediatric Cardiology Department, Pediatric Hospital Carmona da Mota, CHUC EPE, Coimbra, Portugal
António Pires
Affiliation:
Pediatric Cardiology Department, Pediatric Hospital Carmona da Mota, CHUC EPE, Coimbra, Portugal
*
Correspondence to: P. Vaz Silva, Av. Afonso Romão, Santo António dos Olivais. 3000-602 Coimbra, Portugal. Tel: +351 239488700; Fax: +351 239717216; E-mail: [email protected]
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Abstract

Coronary artery fistulae are uncommon but may be haemodynamically significant, being an incidental finding in 0.1–0.2% of coronary angiograms. Even rarer is the association between fistulae and non-atherosclerotic coronary artery aneurysms. They most frequently originate in the right coronary artery, and the right cardiac chambers are the most common draining chambers. Most children are asymptomatic, whereas those older than 20 years may present with signs of congestive heart failure, infective endocarditis, myocardial ischaemia, or aneurysm rupture. Management is either surgical or via percutaneous means. We report the case of a 5-year-old child referred for assessment of an asymptomatic cardiac murmur. The echocardiographic evaluation showed an enlarged right atrium, a fenestrated atrial septal defect, and a giant right coronary artery aneurysm with a fistulous tract that appeared to drain directly into the right atrium. Computed angiocardiac tomography and cardiac catherisation confirmed the presence of a large right coronary fistula originating from the right coronary aneurysm draining into the right atrium. The patient underwent surgical ligation of the fistula and the post-operative course has been uneventful. He is currently on double antiaggregation therapy.

Keywords

Right coronary aneurysmcoronary fistulafenestrated atrial septal defect
Type
Brief Reports
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 528 - 530
Copyright
Copyright © Cambridge University Press 2013 

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