# Unlocking the Hidden Pathway: A Rare Encounter With Right Coronary Artery Fistula to Coronary Sinus and Right Ventricle

## TL;DR

This paper reports a rare case of a coronary artery fistula in a 62-year-old man and highlights the importance of early detection and management for better outcomes.

## Contribution

The novelty lies in presenting a rare and complex case of a right coronary artery fistula to the coronary sinus and right ventricle.

## Key findings

- The patient had a significant CAF from the right coronary artery to the coronary sinus and right ventricle.
- Despite no major artery blockages, the fistula was considered clinically significant due to potential myocardial ischemia.
- The case emphasizes the need for early recognition and tailored management of CAFs.

## Abstract

Coronary artery fistulas (CAFs) are rare vascular anomalies characterized by abnormal connections between coronary arteries and cardiac chambers or adjacent structures. Advances in cardiac interventions have led to an increasing recognition of acquired CAFs, which are typically congenital. We present a case of a 62-year-old male with a complex medical history, including hypertension, atrial fibrillation, and heart failure, who presented with exertional chest pain and palpitations. Diagnostic evaluation revealed a significant CAF originating from the right coronary artery (RCA) and terminating into the coronary sinus and right ventricle. Despite the absence of significant coronary artery occlusions, the fistula was deemed clinically significant due to its potential to cause myocardial ischemia. Management involved guideline-directed medical therapy and lifestyle modifications. This case underscores the importance of early recognition and appropriate management of CAFs to optimize patient outcomes. Further research is needed to better understand the natural history and optimal management strategies of CAFs.