Congestive Heart Failure in a Patient with Giant Aneurysm-like Right Coronary AV Fistula

Coronary arteriovenous fistula is a rare congenital cardiac anomaly. Symptoms may be mild or absent in young patients, and some are associated with other anatomic anomalies. Angiography remains the gold standard for diagnosis and a guide to therapy, although other noninvasive modalities are increasingly useful. Both surgery and coil embolism are options for correcting this anomaly. The final choice, however, depends on the precise anatomic distribution of the fistula. Here we report a patient who had a giant aneurysm-like right coronary artery resulting from a fistula terminating in the coronary sinus and another fistula arising from the circumflex artery. Surgical ligation was chosen over coil embolism to prevent unintended distal embolism. The patient underwent a successful operation and no longer experienced her previous symptoms.