Presentation
Young female with exertional chest pain.
Patient Data
Normal origin of the right and left coronary arteries. Right dominant coronary artery circulation.
Dilatation, serpiginous configuration, and elongation of the right coronary artery which courses along the inferior atrioventricular groove and into the left ventricle (LV) myocardium terminating in the LV cavity at the level of the basal inferolateral segment just inferior to the mitral valve, consistent with a coronary cameral fistula.
Case Discussion
Coronary cameral fistulas are abnormal communications between a coronary artery and a cardiac chamber. The right coronary artery (RCA) is the most commonly involved artery while the left ventricle (LV) is the least commonly involved cardiac chamber.
The case is an example of an uncommon RCA-LV fistula of the arterioluminal subtype with a direct connection between the coronary artery and the cardiac chamber. It represents a left-to-left shunt.
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