Surgical management of coronary-cameral fistula with aneurysmal right coronary artery

Coronary artery fistulas (CAFs) are rare vascular malformations that can result in catastrophic outcomes for patients. The development of CAFs is often accompanied by significant dilation and/or aneurysmal changes in the supplying coronary artery. Management of CAFs depends on the symptomatic status. We report a 52-year-old woman who presented to our hospital with unexplained chest tightness and pain for 2 weeks. Definitive diagnosis of a right CAF with aneurysmal dilation was established through comprehensive evaluation. The patient underwent surgical intervention involving incision at the proximal posterior atrioventricular groove coronary aneurysm, with successful fistula ligation via continuous suture closure. CAF are rare, often clinically silent anomalies of significant pathophysiologic importance, with a risk of lethal complications. This case demonstrates the feasibility and technical considerations of open surgical repair for a giant saccular coronary aneurysm secondary to fistula. It underscores the importance of an individualized surgical strategy in managing such complex anatomy.