Coronary cameral fistula manifested as angina pectoris in a 40-year old female

Figure 1. A) Transthoracic echocardiography in long-axis view shows dilated left circumflex artery and a B) flow inside on color Doppler. C) Short axis view on the level of aortic valve and coronary ostia shows dilated left aortic sinus and left main coronary artery and D) on color Doppler a flow seen inside dilated left circumflex artery (LCX). E) Modified apical 4 chamber view shows the track of dilated LCX terminated in right atrium (RA) with F) color Doppler flow directed toward RA demonstrating the coronary cameral fistula. Video: https://youtu.be/oeam42nz3V8

Figure 2. Coronary computed tomography angiography of the coronary arteries using maximum intensity projection images shows dilated left main (LM) coronary artery (thin red arrow) with dilated left circumflex (LCX) artery (green arrow) that directed toward right atrium (RA). An aneurysmal formation of distal LCX seen before opening into RA (thick red and white arrows). Abbreviations: descending aorta, DA; right aortic sinus, RAS; non-coronary sinus, NCS; left aortic sinus, LAS.

Figure 3. Three-dimensional volume rendered reconstruction images of cardiac computed tomography angiography showing dilated both left main (LM) and left circumflex (LCX) coronary artery with aneurysmal part of LCX before opening into right atrium (RA) – LCX-RA fistula.

Figure 4. The opening of fistula into the right atrium during operative treatment (black arrow).

Figure 5. A) Resected track of dilated left circumflex artery. B) Resected part of left main coronary artery.

Figure 6. Reconstructed computed tomography angiography (volume rendering technique images) after the surgical repair of the coronary fistula and coronary artery bypass grafting. Abbreviations: saphenous venous graft to obtuse marginal branch, SVG-OM; saphenous venous graft to ramus intermedius artery, SVG- ramus intermedius; left internal mammary artery to left anterior descending artery, LIMA-LAD.