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An asymptomatic, 49 year old, white male was noted to have mild cardiomegaly on routine chest radiography. Transthoracic echocardiography revealed a prominent right sinus of Valsalva and an ill defined mass that appeared to be in the right atrium. Transoesophageal echocardiography showed a large vascular structure in the right atrial (RA) wall and an enlarged coronary sinus (CS). Aortography confirmed the presence of a large coronary–cameral fistula. During surgical obliteration it was found to originate at the right coronary artery sinus and empty into the coronary sinus, just proximal to its entry into the right atrium.
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