A Rare Case of Congenital Coronary Artery Fistula Evaluated by Cardiac MRI
In a patient with coronary artery fistula extending from anterior aortic sinus to postero-superior wall of right atrium, Magnetic Resonance Imaging was able to accurately demonstrate dilatation of the involved coronary artery, the tortuous nature of the dilated fistula, blood flow within the fistula and its communication with right atrium. Coronary artery fistulas are among the rare anomalies of coronary arteries. Role of angiography is well established in identification and characterization of these anomalies, however their accurate course and termination is often not defined. We demonstrate role of cardiovascular MRI in non- invasively diagnosing and characterizing the course of these anomalous coronary branches. Here we report a rare case of coronary artery fistula, symptomatic due to hemodynamically significant coronary steal phenomenon. Magnetic Resonance Imaging revealed abnormal dilated tortuous channel extending from anterior aortic sinus and postero-superior wall of right atrium suggestive of right coronary artery fistula. Large opening of the fistula was repaired with SFD patch and opening of the fistula in right atrium was closed directly with prolene.
Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 103-108