case_images: PMC10535103_01
case_images: Preoperative chest radiography (A) and transthoracic echocardiogram (B, C) revealed the partially enlarged heart shadow (A, arrow), right coronary artery enlargement (B, arrow), pseudoaneurysm (C), and right coronary artery to right atrium fistula (C, D). AO, ascending aorta; PV, pulmonary vein; RA, right atrium; RCA, right coronary artery.
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case_images: PMC10535103_01_fcvm-10-1233873-g001.jpg
case_images: F1
case_images: An electrocardiogram revealed a normal rhythm, while a chest x-ray exhibited an enlarged RA (Figure 1A). The RCA was observed originating from the right coronary sinus, curving rightward and posteriorly before turning leftward to connect with the lateral wall of the RA (Figure 1B). Color Doppler imaging corroborated the presence of a left-to-right shunt during both systole and diastole (Figures 1C,D).
case_images: Cardiac computed tomography angiography preoperatively confirmed that the right coronary artery was significantly enlarged (A, arrow) to form a pseudoaneurysm (B), with the right superior pulmonary vein remarkably compressed (B, C, arrow). Three-dimensional reconstruction of the cardiac CTA indicated that the enlarged right coronary artery was tortuous (D, E) and the left coronary artery functioned normally (F, arrow). CTA, computed tomography angiography.
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case_images: F2
case_images: In contrast, the left coronary artery demonstrated unimpaired function (Figure 2).
case_images: Intraoperative view showing a cystic lesion located beneath the right and above the right superior pulmonary vein (A-C). AO, ascending aorta; RA, right atrium; RV, right ventricle; SVC, superior vena cava.
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case_images: F3
case_images: During the surgical intervention, a pronounced enlargement of the RCA pseudoaneurysm, along with multiple fistulas extending into the RA, became evident (Figure 3).
case_images: Transthoracic echocardiogram (TTE) and coronary computed tomography angiography at discharge (day 7 postoperatively) indicated that the valves functioned well (A) and the right superior pulmonary vein was decompressed (B, arrow). The pseudoaneurysm was removed (C) No tortuous artery or enlargement was detected in the coronary arteries (D).
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case_images: F4
case_images: Subsequent postoperative evaluations, encompassing transthoracic echocardiography and coronary computed tomography angiography, corroborated the successful functioning of the heart valves and coronary artery, with no evidence of stenosis (Figure 4).