Aneurysm of Sinus of Valsalva with Fistula to the Coronary Sinus

A 63-year-old female with hypertension, evaluated for atypical chest pain and continuous precordial murmur, was found to have an insignificant stenosis in the proximal right coronary artery with a large tortuous fistula originating from the right sinus of Valsalva to the coronary sinus draining into the right atrium with an unusual course parallel to but distinct from the right coronary artery. Multidetector computed tomographic coronary angiography and cardiac catheterization confirmed the diagnosis. Such an anomaly has not been reported earlier.