Coronary artery anomalies (CAF) is a rare congenital anomaly with a prevalence of 0.2-2%. It is defined as an abnormal communication between a coronary artery and a cardiac chamber bypassing the capillary bed or any part of the systemic or pulmonary. Guidelines on the diagnosis and management of CAF are still inconsistent and evolving due to its' differing pathophysiologic mechanisms and clinical presentation. A case of a 39 year old female who consulted at our institution due to intermittent palpitations diagnosed with coronary artery fistula underwent repair of coronary artery fistula. Intraoperatively they found a 3 mm opening noted 6 mm inferior to left main coronary artery ostium, coursing along the superior border of the left atrium underneath the SVC and ends into the right atrium. The fistula was plicated in a layered fashion. The patient tolerated the procedure and was discharged improved.
CAF are rare anomalies that are often asymptomatic. However, the "coronary steal" phenomenon can result in a variety of cardiac symptoms. Work up and imaging that can be done include echocardiography, CT scans and the gold standard, angiography. Treatment options include minimally invasive transcatheter closure or surgical ligation. These are low risk procedures with good prognosis on low term follow up