Abstract
Coronary cameral fistulas (CCFs) are rare coronary artery anomalies characterized by direct communication between the coronary artery and cardiac chamber. We present the case of a 26-year-old man with a continuous cardiac murmur and cardiomegaly. Studies revealed a giant fistula originating from the proximal right coronary artery (RCA) and draining into the right atrial auricle with a Qp/Qs ratio of 1.76 and markedly elevated cardiac output. Owing to the aneurysmal configuration and anatomic suitability, the patient underwent successful off-pump resection of the fistula and reconstruction of the RCA using a radial artery graft. The patient recovered uneventfully and remained asymptomatic four years postoperatively, with no evidence of recurrence or ischemia. This case demonstrates that off-pump surgical resection with coronary reconstruction can be a safe and effective approach in selected patients with large coronary camera fistulas, provided that meticulous preoperative planning and intraoperative monitoring are ensured.
