Coronary-Cameral Fistula from RCA to RA Masquerading as RSOV: A Case Report

Introduction: Coronary-cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal communications between a coronary artery and a cardiac chamber. These fistulas can pose significant diagnostic challenges when they mimic other cardiac pathologies such as ruptured sinus of Valsalva (RSOV), especially given the overlapping clinical presentations and hemodynamic implications.Case Report: We present the case of a ۲۴-year-old female who experienced chronic chest pain and intermittent dyspnea, initially suspected to have RSOV into the right atrium (RA) based on transthoracic echocardiography. Further evaluation with computed tomography angiography revealed a dilated and tortuous right coronary artery (RCA) terminating directly into the RA, confirming a diagnosis of coronary-cameral fistula. Intraoperative assessment corroborated the imaging findings, revealing a large single fistulous ostium from the RCA to the RA without evidence of RSOV, congenital septal defects, or coronary ostial abnormalities. The fistula was surgically ligated, and the patient had an uneventful postoperative recovery with symptom resolution.Conclusion: This case highlights the diagnostic complexity in differentiating CCFs from RSOVs, particularly when advanced imaging is not initially employed. The congenital nature, anatomical location, and absence of associated structural anomalies underscore the unique presentation of this fistula. Multimodality imaging, including cardiac CT and intraoperative confirmation, proved crucial in delineating the precise anatomy and guiding appropriate surgical management. CCFs, although rare, must be considered in the differential diagnosis of RSOV. Accurate anatomical delineation through advanced imaging techniques is essential for effective management. This case reinforces the importance of a multidisciplinary approach and high-resolution imaging in the evaluation of complex congenital coronary anomalies.

کلیدواژه ها:

Coronary Cameral Fistula ، Congenital coronary anomaly ، RSOV