Right Coronary Artery-to-Right Atrial Fistula Accompanied by Multiple Right Coronary Artery Aneurysms: A Case Report

TL;DR

A 68-year-old woman with a rare heart condition involving a fistula and aneurysms was managed medically without surgery.

Contribution

This case report highlights the management of a rare combination of a coronary artery fistula and aneurysms without interventional procedures.

Findings

The patient was asymptomatic initially but later developed atrial fibrillation.

Medical management with metoprolol successfully restored normal heart rhythm.

Progressive fistula expansion and concurrent aneurysm development were observed on follow-up imaging.

Abstract

A coronary artery aneurysm (CAA) denotes a localized dilation of the coronary artery, while a coronary artery fistula signifies an aberrant connection between a coronary artery and a cardiac chamber or adjacent vessel. Here, we present a case study of a 68-year-old female with a previously diagnosed right coronary artery-to-right atrial fistula concomitant with multiple right coronary artery aneurysms. Initially asymptomatic, the patient subsequently manifested atrial fibrillation. Management involved augmenting the patient’s home regimen with metoprolol tartrate, followed by successful cardioversion and restoration of sinus rhythm. Given the stability of the fistula and the absence of symptomatic exacerbation, no further interventional measures were undertaken. The patient was discharged with an adjusted metoprolol regimen and scheduled follow-up with her cardiologist. Subsequent imaging assessments unveiled progressive fistula expansion alongside the development of concurrent CAA, inciting deliberations concerning optimal treatment modalities.

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