Coronary cameral fistula with left main coronary artery aneurysm: A challenging case

Coronary fistulae with cardiac chambers (cameral fistulae) are rare congenital vascular anomalies. Here, we are reporting a case of a 25-year-old male patient who presented with a history of palpitation and chest pain. He was evaluated further and on cardiac multi-slice computed tomography, he was diagnosed to have an extremely rare coronary cameral fistula arising from the left main coronary artery, traversing tortuously between aortic roots anteriorly and left atrium posteriorly, and culminating into superior vena cava just before the cavoatrial junction. Intraoperative complexity was encountered due to the presence of a large left main coronary aneurysm and aneurysmally dilated superior vena cava. Elective surgery was performed on cardiopulmonary bypass with aortic and bicaval (high superior vena cava) cannulation. Cardioplegia delivery was challenging due to the presence of a large fistulous connection between the aortic root and superior vena cava. The patient was operated on successfully for coronary cameral fistula and symptoms resolved.