Giant Circumflex Coronary Artery Fistula Draining into the Coronary Sinus

Coronary artery fistulas are rare congenital anomaliesarising from an abnormal direct connection between any coronary arteries and a cardiac chamber, a great vessel or the coronary sinus. In this case report we present a rare case of a giant fistula beetwen the first marginal branch of the circumflex coronary artery and the coronary sinus in a patient symptomatic for dyspnea and palpitation. A selective coronary angiography revealed the presence of a fistula between a coronary artery and the coronary sinus. A contrast-enhanced ECG-gated multi-dector computed tomography confirmed the presence of a giant coronary artery fistula between the first obtuse marginal branch of the circumflex coronary artery and coronary sinus. Due to the rapid progression of the fistula diameter and symptoms, the patient underwent to a surgical closure of the fistula. At six months follow up, the patient was in excellent condition and asymptomatic for dyspnea, palpitation or chest pain. A control contrast-enhanced ECG-gated multi-dector computed tomography showed a complete closure of the fistula without residual shunt.