Right Coronary Artery to Superior Vena Cava Fistula Following CABG: A Very Rare Case Report

Although most of the Coronary Artery Fistulae to venous system are congenital , we present a case who was treated conservatively and developed an acquired post CABG fistula formation between Right Coronary Artery and Superior Vena Cava that due to with allow-flow shunt and few symptoms. Case presentation We present a 65 year-old man with history of CABG 3 years earlier who present with chest pain. He had developed a 3-vessel diseases well as a recent Myocardial Infarction (MI) with reduced EF (EF= 25%) he presented a Chest Discomfort since 2 month after discharge that increasing by any physical activity. Consultant Cardiologist decided to perform Coronary Angiography to assess the condition of Native Coronary Artery and also Coronary Grafts well. on coronary angiography all of grafts was patents and but there was an abnormal communication between proximal of native Right Coronary Artery and Superior Vena Cava that finally fill the Right Atrium. Conclusion Clinically, although most of Coronary Artery Fistulae are silent and asymptomatic due to Limited amount of shunt, but in some rare cases in which there is a large shunt and steal of coronary circulation, symptoms and signs of Ischemic Heart disease appears that there are surgical and interventional options for closure of this abnormal communications.