Acute Myocardial Infarction Revealing a Thrombotic Right Coronary Artery – Superior Vena Cava Fistula: a case report

Abstract Background Coronary artery fistulas (CAFs) are rare coronary anomalies that can occasionally lead to thrombotic complications and myocardial infarction. Their diagnosis and management remain challenging due to variable anatomy and low prevalence. Case summary A 29-year-old man presented with inferior ST-segment elevation myocardial infarction five days after orthognathic surgery. Coronary angiography revealed a thrombotic occlusion of the distal right coronary artery (RCA) and a thrombotic fistula arising from the proximal RCA. Successful stenting restored distal flow. Cardiac computed tomography angiography confirmed a right coronary artery–superior vena cava (RCA–SVC) fistula containing thrombus. The patient received dual antiplatelet therapy and anticoagulation. Follow-up imaging at three months showed a patent RCA stent and persistent occlusion of the fistula. Discussion This case illustrates that CAFs, though rare, can lead to acute MI in young adults. CCTA is essential for anatomical assessment, and heart team discussion is key for individualized management.