Right Coronary Artery Aneurysm With Fistula to Left Ventricle

Abstract

A 34-year-old male presented with prior radiographic evidence of enlargement of the right side of the heart. ECG-gated enhanced multislice CT was performed. Axial source images revealed a diffuse, hugely enlarged right coronary artery (RCA) aneurysm. The distal portion of the RCA flowed directly into the left ventricle (LV), suggesting an RCA to LV fistula. 3D volume rendered images clearly revealed a huge, enlarged RCA aneurysm from the proximal, mid, and distal portions of the RCA. The distal portion of the RCA aneurysm disappeared abruptly without showing distal branching, also suggesting an RCA to LV fistula.

Bi-directional flow in coronary-to-left ventricular fistula

“…In addition to providing the diagnosis, contrast-enhanced cardiac computerized tomographic angiography can offer accurate anatomic delineation of the arterial source. Threedimensional volume rendering allows stereotactic evaluation of the proximal and distal fistulous openings, as well as the parent vessel [5]. Our patient's age and clinical stability, as well as personal preference for conservative therapy, argued against such further evaluations.…”

Right Coronary Artery Fistula to Left Ventricle Complicated with Huge Coronary Artery Aneurysm

“…The as- sociation of CAF with coronary artery aneurysm is even more rare (4). This aneurysm is regarded as one of the complications of CAF, where the RCA communicates with the left ventricle, as published in a few English language reports (13,14). Most of the patients with CAF older than 20 years, although they may remain asymptomatic as in this case, develop symptoms, like angina pectoris (14,15) and infective endocarditis (16), with fistula-related complications with increasing age.…”

A rare, giant coronary artery ectasia coexisting with a coronary artery fistula in an older infant

“…Concurrence of a coronary artery fistula and coronary artery ectasia is extremely rare 1 . Most coronary artery fistulas are asymptomatic.…”

“…Concurrence of a coronary artery fistula and coronary artery ectasia is extremely rare. 1 Most coronary artery fistulas are asymptomatic. Symptomatic coronary artery fistulas are rare in infants, and CT is useful for the diagnosis.…”