Left main coronary artery to right atrium fistula presenting with syncope: a case report

Coronary cameral fistula (CCF) is a rare coronary anomaly involving an abnormal communication between a coronary artery and a cardiac chamber or great vessel. While often asymptomatic, large fistulae may result in myocardial ischaemia, arrhythmias, or heart failure.

A 38-year-old woman presented with palpitations, dizziness, and syncope. Clinical examination revealed a continuous murmur. Transthoracic echocardiography demonstrated right-sided chamber enlargement. Cardiac magnetic resonance imaging identified a large fistula originating from the left main coronary artery draining into the right atrium, with a Qp:Qs of 1.3. Cardiac computed tomography provided detailed anatomical delineation. Coronary angiography confirmed the diagnosis and demonstrated suitability for percutaneous intervention. Successful transcatheter closure was performed using a 10 mm Amplatzer Vascular Plug II, with immediate cessation of flow and subsequent symptom resolution.

This case highlights the diagnostic value of multimodality imaging in defining fistula anatomy, quantifying shunt burden, and guiding procedural planning. Transcatheter closure is a safe and effective treatment strategy for haemodynamically significant CCF.