Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

Abstract

Coronary artery fistulae, which are connections between coronary artery branches and cardiac chambers or major vessels, are usually congenital forms of coronary artery anomalies, but rarely may be acquired because of cardiac trauma, neovascularity in association with cardiac neoplasm, mural thrombus formation, or iatrogenic causes. Although half of the patients with coronary artery fistula remain asymptomatic, these fistulae may lead to angina, syncope, congestive heart failure, myocardial infarction, and sudden death. Here we present a case of coronary artery fistula between right coronary artery and left atrium through a large left atrial thrombus in a patient with rheumatic mitral stenosis. The diagnosis was confirmed using echocardiography, conventional and multislice computed tomography, and coronary angiography. To the best of our knowledge, this interesting and unique entity is the first to be reported in the present literature.