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Integrated procedure for giant right coronary aneurysm with fistula and atrial fibrillation – coronary grafting, fistula obliteration and radiofrequency maze

Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, Australia

^* Corresponding author. Tel.: +61-2-9550-1933; fax: +61-2-9550-6669
baysheil{at}netscape.net

Giant coronary artery aneurysm (CAA) with fistula is a rare entity. Surgical treatment is often concomitant to treating obstructing coronary lesions. We report the successful management of a giant right CAA with fistulisation into the right atrium. By coincidence, a secundum atrial septal defect was present. In addition, a radiofrequency maze procedure was performed for atrial fibrillation (AF). This combination of procedures has not been previously reported in the literature. The substantial benefits from regained atrial rhythm and contraction outweigh the potential risks, justifying the combined approach in patients with established AF and organic disorders provided the patients are judged capable of tolerating and benefiting from the procedure.

Key Words: Coronary aneurysms; Coronary fistulae; Radiofrequency maze