Surgical Management of a Right Coronary Artery Fistula After Failed Transcatheter Closure: A Case Report.

A coronary artery fistula (CAF) is an abnormal communication between a coronary artery and a great vessel or cardiac chamber. CAFs are very rare and are mostly of congenital origin, but they can also be acquired. Patients are usually asymptomatic since the majority of CAFs are small in size; hence, most cases are usually discovered incidentally during routine angiographic investigations. Moderate or large CAFs can be symptomatic, causing angina pectoris due to coronary steal phenomenon, and can carry a high risk of serious complications such as myocardial infarction, heart failure, or even sudden cardiac death. Consequently, prompt management with the appropriate choice of intervention - surgical versus transcatheter closure - is essential to prevent such complications. We present a case of a 52-year-old male patient with a right coronary artery-coronary sinus fistula managed with surgical closure.