Surgical closure of the Right Coronary Artery - Right Atrium Fistula and Repair of Tricuspid Regurgitation Following a Failed Transcatheter Closure

Abstract Coronary arteriovenous fistulae (CAF), a rare coronary anomaly with a prevalence of approximately 0.002% in the general population, may be congenital or acquired and are often diagnosed incidentally through cardiac imaging. We describe a surgical closure of the fistula and tricuspid valve repair, following the failed minimally invasive intervention that resulted in rupture of the posterior leaflet chordae of the tricuspid valve. Closure of the fistula with a pericardial patch, along with tricuspid valve repair using a Cosgrove-Edwards annuloplasty ring was successfully performed. This case highlights the importance of timely surgical intervention in managing complications of failed percutaneous procedures for coronary arteriovenous fistulae, emphasizing the value of individualized, multidisciplinary approaches in complex cardiovascular anomalies.