A Rare Case of Giant Aneurysm of the Right Coronary Artery with Right Coronary Artery to Coronary Sinus Fistula

Background: Coronary artery aneurysms are rare, localized, abnormal dilations of the artery.The combination of coronary artery aneurysm and coronary artery to coronary sinus fistula is even more rare.Case Presentation: This report presents a case of a giant right coronary artery aneurysm and a right coronary artery to coronary sinus fistula in a 55-year-old Indian female who presented with chest pain and exertional dyspnea that had been increasing over a six-month period and became severe one week prior to admission.The referral diagnosis was severe aortic regurgitation with a ruptured sinus of Valsalva; however, diagnostic imaging at our center revealed a 100 mm aneurysm of the proximal to mid segment of the right coronary artery with ectasia of the distal right coronary artery and a fistulous connection at the level of its ostium.The patient underwent successful aneurysm resection, fistula closure and coronary artery bypass grafting using great saphenous vein graft to the posterior descending artery.Conclusions: This case highlights the importance of including giant coronary artery aneurysms in the differential diagnosis for patients presenting with chest pain, exertional dyspnea, and a cardiac mass.It also emphasizes the need to investigate for coronary fistulae as a significant associated finding and underscores the diagnostic challenges posed by this complex pathology.