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.