Mysterious window: A right coronary artery‐left ventricular fistula diagnosed by multiple imaging approaches

Prevalence of primary coronary cameral fistula (CCF) is extremely rare, especially for CCF with its drainage channel into the left ventricle (LV). We describe a 45-year-old male patient with giant aneurysm associated with proximal right coronary artery (RCA), and the distal end of RCA draining into the LV through a fistula, which was discovered by echocardiography. Dual-source computer tomography revealed only the CCF-related giant RCA aneurysm. The drainage site of the fistula and the above coexistent abnormality could not be visualized clearly by coronary artery angiography because of deficient contrast medium filling into the aneurysm. The patient underwent surgical resection of the giant aneurysm and occlusion of the fistula in 2015. Finally, the patient accepted another operation to occlude the residual coronary fistula in 2021.

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