Abstract：
BACKGROUND: Right coronary artery (RCA) fistulized to the coronary sinus is rare condition in adult cardiac anomalies, and the management and operative indication are controversial.
METHODS: We describe the case of a 45-year female patient who presented with exertional dyspnea, accompanied by intermitted lower limbs and facial edema. She was diagnosed with severe tricuspid regurgitation second to a severely dilated RCA fistulized to the coronary sinus. After multidisciplinary discussion, she underwent surgery through routine medium sternotomy, the right atrium was opened under cardiopulmonary bypass. The coronary arteriovenous fistula from the distal portion of RC to a severely enlarged coronary sinus was found. Trans-coronary sinus closure of the fistula was performed with continuous stitching and a tricuspid ring annuloplasty was done. The patient recovered uneventful post operation.
CONCLUSIONS: According to current literatures, surgical treatment was adopted for this case, instead of endovascular intervention. The optimal approach for these cases should consider the heart\'s anatomical characteristics. But we need to be aware of the occurrence of myocardial infarction and tricuspid regurgitation in the early and late stage after operation.
METHODS: We describe the case of a 45-year female patient who presented with exertional dyspnea, accompanied by intermitted lower limbs and facial edema. She was diagnosed with severe tricuspid regurgitation second to a severely dilated RCA fistulized to the coronary sinus. After multidisciplinary discussion, she underwent surgery through routine medium sternotomy, the right atrium was opened under cardiopulmonary bypass. The coronary arteriovenous fistula from the distal portion of RC to a severely enlarged coronary sinus was found. Trans-coronary sinus closure of the fistula was performed with continuous stitching and a tricuspid ring annuloplasty was done. The patient recovered uneventful post operation.
CONCLUSIONS: According to current literatures, surgical treatment was adopted for this case, instead of endovascular intervention. The optimal approach for these cases should consider the heart\'s anatomical characteristics. But we need to be aware of the occurrence of myocardial infarction and tricuspid regurgitation in the early and late stage after operation.
摘要：
背景：在成人心脏异常中，右冠状动脉（RCA）位于冠状静脉窦是罕见的疾病，管理和手术指征是有争议的。
方法：我们描述了一名45岁女性患者的情况，该患者表现为劳力性呼吸困难，伴有间歇性下肢和面部水肿。她被诊断出患有严重的三尖瓣反流，仅次于严重扩张的RCA造骨至冠状窦。经过多学科的讨论，她通过常规的中度胸骨切开术接受了手术，右心房在体外循环下开放.发现了从RC远端到严重扩大的冠状窦的冠状动静脉瘘。连续缝合并经冠状窦闭合瘘管，并进行三尖瓣环瓣环成形术。病人术后恢复顺利。
结论：根据现有文献，该病例采用手术治疗，而不是血管内介入。这些病例的最佳方法应考虑心脏的解剖特征。但术后早期和晚期需要注意心肌梗死和三尖瓣反流的发生。
方法：我们描述了一名45岁女性患者的情况，该患者表现为劳力性呼吸困难，伴有间歇性下肢和面部水肿。她被诊断出患有严重的三尖瓣反流，仅次于严重扩张的RCA造骨至冠状窦。经过多学科的讨论，她通过常规的中度胸骨切开术接受了手术，右心房在体外循环下开放.发现了从RC远端到严重扩大的冠状窦的冠状动静脉瘘。连续缝合并经冠状窦闭合瘘管，并进行三尖瓣环瓣环成形术。病人术后恢复顺利。
结论：根据现有文献，该病例采用手术治疗，而不是血管内介入。这些病例的最佳方法应考虑心脏的解剖特征。但术后早期和晚期需要注意心肌梗死和三尖瓣反流的发生。
