A 60-year-old woman with no cardiovascular risk factors, no history of diseases or previous interventions, asymptomatic and without use of drugs who 2 years before the diagnosis initiates a clinical picture characterized by feeling of lack of air with moderate efforts laboratory examination.
This requires an echocardiogram which was reported as completely normal, so it insists on general measures and adds a diuretic in low doses, despite which no improvement is observed.
Subsequently, orthopnea and milder physical limitation are added, associated with occasional rapid episodes of short duration.
For this reason the patient consults a cardiology specialist who detects in the physical examination a continuous murmur in the third and fourth space for left low intensity.
The rest of the test is completely normal.
This finding requires a new echocardiogram in our institution, which shows mild dilation of the right cavities and image of the right coronary artery with probable flow from distal to the right atrial cavity.
An angiographic study is defined by an increase in symptoms, which shows a normal left coronary artery and a large right coronary artery (DCA), a very tortuous course and drains widely in the coronary sinus.
Figure 2 shows a normal RCA and compares it with that of our patient.
The case is discussed requesting the opinion of pediatric interventional cardiologist, and it is defined that due to the size of the fistula the best option is surgical treatment.
During surgery, fistula closure was performed with direct suture, postoperative evolution was uneventful.
Associated with surgery, an angiographic control was performed within the same hospitalization, which showed complete closure of the fistula.
The patient progressed in good condition, asymptomatic at 5 years without events.
