1 ︱ INTRODUCTION
Coronary artery anomaly (CAA) is a common cause of sudden cardiac death,
a congenital disease of abnormal coronary origin, course, and
termination 1. Coronary artery fistula (CAF) is an
abnormally terminated CAA with a low prevalence (0.2-0.6%) and is
usually detected incidentally during the diagnostic examination for
ischemic heart diseases 2. Ischemic symptoms of CAF
are caused by coronary steal where coronary blood flows into
low-pressure areas of the fistula (eg, right ventricle, right atrium,
pulmonary artery, or coronary sinus), resulting in distal myocardium
ischemia. The latest data show that CAF accounts for 0.32% of total
coronary anomalies in Southwest China as determined by angiography3. Especially, a giant left coronary artery aneurysm
that fistula to the right atrium and accompanied by ruptured aortic
sinus aneurysm (RASA) is rarely reported. Notably, even asymptomatic
coronary fistulas can lead to severe complications, such as
endocarditis, coronary aneurysms, myocardial infarction, or cardiac
arrest; therefore, catheter-based closure or surgical therapy is often
required.