Coronary arterial-left atrial fistula: Case with obstruction of the inferior vena cava by a giant left atrium

A 64 year old man with a life-long history of known heart disease and irregular heart action presented with a continuous parasternal bruit, a massively enlarged heart and incomplete inferior vena cava obstruction. Angiocardiograms demonstrated marked distortion of all of the heart chambers, particularly the right atrium, and partial obstruction of the inferior vena cava by a large mass presumably invading the heart. Aortogram demonstrated a large anomalous branch of the right coronary artery, but it was not possible to determine angiographically the termination of the vessel. On exploratory thoracotomy, the mass distorting the heart was determined to be a giant left atrium that was presumably the result of a coronary arteriovenous fistula between the right coronary artery and the left atrium. The angiocardiographic findings are presented in detail, and the postulated factors in the development of giant atriomegaly are discussed.