Congenital Coronary-Cameral Fistula from Right Coronary Artery to Right Ventricle : a Very Rare Case Report

Author : R. Puspitoadhi, M.H. Cahyadi, P.S. Putri, N. Virginia, A. Priyatno
Upload Date : 19-04-2018

Background: Coronary-cameral fistula is a rare cardiovascular anomalies. A coronary artery aneurysm associated with a coronary-cameral fistula is a very rare found in daily practice. Case presentation: A-nine-years old boy presented with palpitation in vigorous intensity activity. On physical examination, there was a continuous murmur III/6 crescendo-decrescendo, diastole accentuation with maximum punctum in ICS IV-V left parasternal line. A standard 12 lead ECG demonstrated atypical T wave inversion in V1-V4, and the chest X-Ray indicated a pulmonary plethora. Transthoracic echocardiography demonstrated an atrial situs solitus with AV-VA concordance, pulmonary veins drainage went to left atrial with a dilation of ostial proximal right coronary artery. There was a turbulence in the apical right ventricle with normal great arteries, and a normal function of left ventricle. In the cardiac catheterization demonstrated a right aneurysmal coronary artery fistula from right coronary artery to right ventricle with the fistula site diameter 2.47 mm, and the feeding vessel came from right coronary artery with diameter 10 mm, and the Qp:Qs was 1.7. An oral antiplatelet was prescribed to the patient to prevent thrombosis. Discussion: Coronary-cameral fistula anomalies is a congenital anomaly of major coronary vascular in 0.002% general population. This anomaly include the origin of coronary, flow distribution, and terminal of the coronary. An Asymptomatic CAVF case does not need to immediate intervention. Treatment by medication and transcatheter or surgical approach more likely to be chosen. Prognostic of the disease depend on the fistula severity. Conclusion: We describe a very rare congenital aneurysmal coronary-cameral fistula from right coronary artery to right ventricle. American College of Cardiology/American Heart Association (ACC/AHA) recommended for closure of the fistula percutaneously or surgical method before the patient developed some complications, especially in pediatric case.

KEYWORDS : Congenital coronary-cameral fistula, Dilated right coronary artery

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