Photoclinic Diagnosis: Coronary Fistula

A12-year-old girl was referred to our hospital with shortness of breath and exertional chest pain lasting for 2 years. She had a history of heart surgery about 5 years ago for a coronary artery fistula. The right coronary artery communicates with the right atrium, and it seems that the surgeon closed one side of the fistula during surgery. Physical examination revealed the following: normal heart sounds without any murmur; lungs, clear; pulse rate, 80 min regular; blood pressure, 110/70 mmHg; routine lab tests, normal; electrocardiography, normal pattern; chest-X ray, cardiothoracic ratio normal; echocardiography, normal. Cardiac catheterization and coronary angiography were performed. There were no atrial septal defects, ventricular septal defect or patent ductus arteriosus. Coronary angiography results are shown in the Figure above.