A dissecting aneurysm of interventricular septum resulting from congenital coronary artery fistula

摘要

Rationale Ventricular septal dissecting aneurysms are rarely caused by congenital coronary artery fistulas. Patient concerns We present a rare case of ventricular septal dissecting aneurysm that resulted from a congenital coronary artery fistula in a 41-year-old female patient with the complaint of chest pain. Diagnosis Ventricular septal dissecting aneurysm resulting from a right coronary artery fistula. Interventions The patient was advised to receive transcatheter interventional therapy in the department of cardiology. Outcomes It was difficult for the cardiac catheter to reach the orifice of fistula due to the long and circuitous nature of the right coronary artery, which ultimately resulted in abandoning interventional fistula occlusion therapy. The patient finally decided to undergo surgical treatment in Shanghai and the symptoms have been markedly improved after hemodynamic correction. Lessons The right coronary artery was the dominant vessel and the fistula was located in the distal part of the posterior descending branch of right coronary artery. Hence, transcatheter closure was appropriate; however, due to the fact that right coronary artery was too long and circuitous, the length of cardiac catheter was relatively insufficient. For this reason, a comprehensive and careful assessment before the operation is necessary.