Right Coronary Artery Fistula Draining into the Right Atrium and Associated with Mitral Valve Stenosis: A Case Report


  • Ali Gürbüz
  • Ufuk Yetkin
  • Ömer Tetik
  • Mert Kestelli
  • Murat Yesil




Coronary artery fistula (CAF) is a rare congenital anomaly of the coronary arteries in which abnormal connections are present between the coronary artery branch and the cardiac chambers or a major vessel. The incidence of CAF is estimated at 1 in 50,000 live births, and it is detected in approximately 0.2% of the adult population during coronary angiography. Reports of the coincidence of mitral stenosis and CAF are rare in the literature. We report a case of CAF and mitral valve stenosis in a patient with dyspnea and fatigue before valve replacement and surgical radiofrequency ablation. Coronary angiography showed a connection between the right coronary artery and right atrium. A fistula opening into the right atrium is rare in patients with coronary artery anomalies and mitral valve disease. Coronary angiography of the patient 1 month after surgical repair showed that the coronary anatomy was normal and the fistula was occluded. CAF can be diagnosed more frequently if coronary angiography is performed simultaneously with cardiac catheterization to evaluate valve functions or nonatherosclerotic myocardial ischemia in each valvular heart disease case. Surgical repair of CAF is the first-choice treatment to prevent complications and improve quality of life.


Ayala F, Badui E, Murillo H, et al. 1996. Coronary fistula associated with double mitral valve disease: a case report. Arch Med Res27:345-7.nBehera SK, Danon S, Levi DS, Moore JW. 2006. Transcatheter closure of coronary artery fistulae using the Amplatzer Duct Occluder. Catheter Cardiovasc Interv68:242-8.nDemirkiliç U, Günay C, Bolcal C, et al. 2003. Early results of endocardial radiofrequency ablation of atrial fibrillation during mitral valve surgery. T Klin Cardiovasc Surg4:159-65.nEnç, Y, Hobikoglu G, Sanioglu S, Sokullu O, Serbetçioglu A, Bilgen F. 1999. Giant coronary arteriovenous fistula draining into the left atrium. J Turkish Thorac Cardiovasc Surg7:331-3.nFernandes ED, Kadivar H, Hallman GL, et al. 1992. Congenital malformations of coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg54:732-40.nGunduz H, Akdemir R, Binak E, Ayarcan Y, Kurtoglu N, Uyan C. 2003. A case of coronary artery fistula with mitral stenosis. Int J Cardiovasc Imaging19:533-6.nHuang YK, Lei MH, Lu MS, Tseng CN, Chang JP, Chu JJ. 2006. Bilateral coronary-to-pulmonary artery fistulas. Ann Thorac Surg82:1886-8.nKayacioglu I, Konuralp C, Idiz M, Akçar M, Çelik S. 2002. A right coronary artery fistula draining into the right ventricle associated with mitral valve stenosis. J Turkish Thorac Cardiovasc Surg10:110-3.nKimura S, Miyamoto K, Ueno Y. 2006. Cardiac tamponade due to spontaneous rupture of large coronary artery aneurysm. Asian Cardiovasc Thorac Ann14:422-4.nLiberthson RR, Sagar K, Berkoben JP, et al. 1979. Congenital coronary arterio-venous fistula: report of 13 patients, review of literature and delineation of management. Circulation59:849-54.nLuo L, Kebede S, Wu S, Stouffer GA. 2006. Coronary artery fistulae. Am J Med Sci332:79-84.nMcClung JA, Belkin RN, Chaudhry SS. 1996. Left circumflex coronary artery to left atrial fistula in a patient with mitral stenosis: invasive and noninvasive findings with pathophysiologic correlation. Cathet Cardiovasc Diagn37:52-4.nOkubo M, Nykanen D, Benson LN, et al. 2001. Outcomes of transcatheter embolization in the treatment of coronary artery fistulas, catheterization and cardiovascular interventions. Catheter Cardiovasc Interv52:510-7.nShyam Sunder KR, Balakrishnan KG, Tharakan JA, et al. 1997. Coronary artery fistula in children and adults: a review of 25 cases with longterm observations. Int J Cardiol58:47-53.nSpektor G, Gehi AK, Love B, Sharma SK, Fuster V. 2006. A case of symptomatic coronary artery fistula. Nat Clin Pract Cardiovasc Med3:689-92.nTanriverdi H, Seleci D, Semiz E. 2006. Angiographic detection of the left anterior descending and the right coronary artery after fistulas into the pulmonary artery in a patient with rheumatic mitral stenosis. Int J Cardiol109:139-41.nTengiz S, Ercan E, Yakut N, Akilli A, Ertürk Ü. 2002. Can optimal results be obtained by coil embolization of multiple coronary arteriovenous fistulas? J Turkish Thorac Cardiovasc Surg10:184-6.nTirabassi G, Muia N, Gaddi O. 2006. Echocardiographic evaluation of coronary artery fistula connecting the right coronary artery to the coronary sinus: a case report. J Cardiovasc Med (Hagerstown) 7:560-2.nVaturi M, Sagie A, Shapira Y, et al. 2001. Impact of atrial fibrillation on clinical status, atrial size and hemodynamics in patients after mitral valve replacement. J Heart Valve Dis10:763-6.nYamanaka O, Hobbs RE. 1990. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn21:28-40.n



How to Cite

Gürbüz, A., Yetkin, U., Tetik, Ömer, Kestelli, M., & Yesil, M. (2007). Right Coronary Artery Fistula Draining into the Right Atrium and Associated with Mitral Valve Stenosis: A Case Report. The Heart Surgery Forum, 10(4), E325-E328. https://doi.org/10.1532/HSF98.20071002