Unusual presentation of Right Coronary Artery Fistula
A 70 years old female patient with no previous comorbidities, was referred with suspected heart failure due to mild exertional dyspneoa, mildly elevated BNP (139ng/L) and inferolateral T inversion on ECG. A transthoracic echocardiogram (TTE) showed a moderate global pericardial effusion, mild left ventricular hypertrophy (LVH), serial TTEs showed a resolving pericardial effusion, moderate LVH and bi-arterial dilation, following which cardiac magnetic resonance imaging (CMR) was requested to exclude infiltrative cardiomyopathy. An angiogram was also requested to exclude infiltrative cardiomyopathy, as a work up for future valve replacement. CMR showed a severely dilated and tortuous Right Coronary Artery (RCA) on Half-fourier -Acquired single -shot turbo spin Echo (HASTE) planning images , draining into an enlarged coronary sinus. There was moderate lateral wall hypertrophy on cine images, with corresponding oedema ( increased native T1 mapping, with enhancement on early and late gadolinium imaging). The RCA to coronay sinus Fistula was also confirmed on the coronay angiogram. The lateral wall hypertrophy or oedema was thought to be a direct consequence of the reduced venous drainage from the lateral wall due to high pressures in the coronary sinus.
A research authored by
Ahmed MSeK Abdelaty
Gerry P McCann