Case presentation:
An asymptomatic nine-year-old boy was presented to our hospital for
evaluation of a continuous murmur that was heard during routine
examination. Transthoracic echocardiogram (TTE) revealed a large
communication between the right coronary artery and the right ventricle
near the tricuspid valve. The diagnosis of a right coronary fistula to
the right ventricle was confirmed by multislice cardiac computed
tomography (MSCT) (Figure 1, 2). The patient was scheduled for elective
surgical repair. The operation was performed via median sternotomy with
complete cardiopulmonary bypass and cardiac arrest. The dilated right
coronary artery was opened longitudinally and a large opening connecting
with the right ventricle was seen on the floor of the artery (Figure 3).
The right atrium was opened and the orifice of the fistula was seen near
the commissure between the posterior and septal leaflet of the tricuspid
valve. This orifice was closed by pledgeted 5/0 prolen sutures. The
fistula in the right coronary artery was close by fine 7/0 prolen
sutures, and the right coronary artery arteriotomy was closed by fine
8/0 suturing to restore its patency. The remainder of the operation was
completed uneventfully. Postoperative TTE showed no residual fistula
with normal myocardial function. The patient was followed up for one
year and was asymptomatic with normal physical activity.