Extract

A 61-year-old man presented with 1-month history of chest pain on exertion. Two-dimensional transthoracic echocardiography showed a dilated right coronary artery (RCA) and coronary sinus (CS) in a parasternal long-axis view (Figure A). The diameter of the RCA was 14 mm at the origin, the middle and the distal part of the RCA in the atrioventricular groove was preserved as well (Figures B and C). In addition, the CS was apparently dilated, and the drainage site was identified. Colour Doppler echocardiography showed a turbulent flow into the right atrium from the CS (Figure D, arrow). Continuous Doppler echocardiography revealed a continuous-wave flow with a maximal velocity of 4.2 m/s at the drainage site.

Right coronary angiography confirmed a large and tortuous RCA, and a distal fistula was identified (Figure E, arrows). Three-dimensional cardiac computed tomographic scanning demonstrated a dilated RCA and a fistula between the RCA and the CS (Figure F, arrow). The patient underwent surgical treatment; in addition to close the fistula site with polypropylene sutures, the RCA prior to the posterior descending coronary artery was resected, and the posterior descending coronary artery was bypassed with the saphenous vein graft. He did well post-operatively.

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