December 2007 Vol 8 After Meeting.indd


Congenital Right Coronary Artery Fistula

*Hilal Alsabti,1 Madan M Maddali2

SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 
DECEMBER 2007 VOL 7, NO. 3, P. 263-264
SULTAN QABOOS UNIVERSITY©
SUBMITTED - 17TH JUNE 2007
ACCEPTED - 1ST SEPTEMBER 2007

I N T E R E S T I N G  M E D I C A L  I M A G E

االمين التاجي للشريان الناسوراخللقي

مادالي موهان مادان و السبتي علي هالل

1Department of Surgery, Sultan Qaboos University, P. O. Box 35, Al-Khod 123, Muscat, Sultanate of Oman; 2Department of Anesthesia, Royal Hos-
pital, Muscat, Sultanate of Oman

*To whom correspondence should be addressed. Email: alsabti@hotmail.com

artery (RCA) was dominant with no lesion, but a fistula
was seen connecting the RCA to the main pulmonary 
artery (PA) [Figure 1].

A congenital coronary artery fistula (CAF) is a rare
identity defined as an abnormal communication be-
tween the coronary artery and either cardiac chambers, 
great vessels, coronary sinus or other close structures 
bypassing the myocardial capillary network.1 The most
common symptoms and complications of CAF include 
fatigue, dyspnea, orthopnea, angina, endocarditis, my-
ocardial ischaemia and myocardial infarction.2

 Despite coronary angiography being the gold 
standard3 for the diagnosis of a CAF, echocardiography 
helps in localizing the orifice, course and drainage of
a fistula. Multi-slice computed tomographic (MSCT)
imaging along with ECG gated angiography can be very 
helpful in the precise evaluation of the malformation.4

Closure of the CAF is highly recommended because 
of the risk of endocarditis and other complications, es-
pecially as closure is safe and effective either through
surgery or a transcatheter intervention.5

R E F E R E N C E S

1. Levin DC, Fellows KE, Abrams HL. Hemodynamically 
significant primary anomalies of the coronary arteries:
angiographic aspects. Circulation 1978; 58:25-34.

2. Gowda RM, Vasavada BC, Khan IA. Coronary artery fis-
tulas: Clinical and therapeutic consideration. Int J Car-
diol 2006; 107:7-10.

3. Vavuranakis M, Bush CA, Boudoulas H. Coronary ar-
tery fistulas in adults: incidence, angiographic charac-
teristics, natural history. Cathet Cardiovasc Diagn 1995; 
35:116-120.

A FIFTY-ONE YEAR OLD LADY WITH A HIS-TORY of dyslipidemia presented to the Royal Hospital, Muscat, Oman, with progres-
sive exertional dyspnea and angina (Class I of Cana-
dian Cardiovascular Society) of one year’s duration. 
At physical examination, a mild continuous murmur 
could be heard mainly at the level of the second inter-
costal space of the left parasternal area. The coronary
angiogram showed a normal left anterior descending 
artery and a left circumflex artery. The right coronary

Figure 1: Coronary angiogram showing the coro-
nary artery fistula (C AF) arising from the right 
coronary artery (RC A) to the main pulmonary 
artery( MPA)



H I L A L  A L S A B T I ,  A N D  M A D A N  M O H A N  M A D D A L I 2

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4. Utsunomiya D, Nishiharu T, Urata J, Ino M, Nakao K, 
Awai K et al. Coronary arterial malformation depicted 
at multi-slice CT angiography. Int J Cardiovasc Imaging. 
2006; 22:547-551.

5. Perry SB, Rome J, Keane JF, Baim DS, Lock IE. Tran-
scatheter closure of coronary artery fistulas. J Am Coll
Cardiol 1992; 20:201-209.