Giant Right Coronary Artery Aneurysm With Coronary Sinus Communication: Challenges In Surgical Management

We report a rare case of a giant right coronary artery (RCA) aneurysm (56 × 58 mm) with a fistulous communication to the coronary sinus, causing right atrial and ventricular compression in a 47-year-old female presenting with heart failure. Multimodality imaging confirmed the diagnosis. Surgical management included aneurysm resection, fistula closure, and saphenous vein grafting to the distal RCA. Despite initial stabilization, the patient developed low cardiac output and died postoperatively. This case highlights the diagnostic and surgical challenges of giant RCA–coronary sinus fistulas and underscores the need for early recognition and timely intervention to prevent fatal outcomes. Keywords: Coronary artery aneurysm, Coronary fistula, Right coronary artery, Coronary sinus, Aneurysmectomy, Case report