Aneurysmal Pipe to Congested Pump

A 46-year-old female presented with dyspnea for 2 years and pedal edema for 6 months. The patient is a known case of ostium secundum atrial septal defect postsurgical closure 20 years back and had a history of successful ablation of atrial flutter 1 year back. On examination, the patient had features of right heart failure and a continuous murmur at the right infraclavicular area. A transthoracic echocardiogram showed a dilated proximal right coronary artery, which was confirmed by a transesophageal echocardiogram. Computed tomography coronary angiogram showed a dilated sinus nodal artery branch draining into the right atrium, which was confirmed by an invasive coronary angiogram. Considering the risk of resurgery and patient preference, the device closure of the fistula with a vascular plug was done. Postprocedure patient symptoms dramatically improved, and the follow-up echo showed no residual shunt.