Brief communication

Atherosclerotic coronary artery aneurysm progressing to coronary artery fistula: Presentation as myocardial infarction with continuous murmur

We present a case of a young woman with symptoms of acute myocardial infarction and found to have a nonatherosclerotic coronary aneurysm of the right coronary artery, which ruptured and formed a pseudoaneurysm. The pseudoaneurysm was sufficiently large that it mimicked an atrial mass on diagnostic imaging modalities. With the attendant risk of further rupture and compression of the heart chambers, the patient underwent successful resection of the aneurysm and pseudoaneurysm with single vessel bypass surgery. (J Am Soc Echocardiogr 2002;15:736-8.)

Acquired coronary artery fistulas have been reported as complications of chest trauma and coronary angioplasty, or after rupture of a coronary aneurysm. We describe a patient who developed a circumflex coronary artery fistula that communicated with a left ventricular false aneurysm after myocardial infarction.