Giant tortuous right coronary artery to coronary sinus fistula with severe tricuspid regurgitation.

We report a case of a giant tortuous right coronary artery to coronary sinus fistula with severe tricuspid regurgitation in a 78-year-old female. The initial working diagnosis was based on clinical manifestations and echocardiography, further supported with computed tomography coronary angiography. The fistula was surgically closed with satisfactory results. This case highlights the rarity and complexity of giant right coronary artery fistulas, and the current challenges of diagnosing and managing these fistulas, particularly in older adults. It explores the role of imaging in clinical evaluation, and the ongoing need for research and monitoring of long-term postoperative outcomes.