Coronary artery fistulae are rare anomalies in which a communication is present between a coronary artery and either a cardiac chamber or another vascular structure, such as the pulmonary artery or coronary sinus. Most fistulae are congenital in origin, but they can also occur as a result of chest trauma or endocardial biopsy. The presence of a fistula is a rare occurrence in itself, but the different origins and drainage sites of fistulae are what make them even more rare. We report the case of a 74-year-old woman with a history of progressive congestive heart failure who was found to have a large left main coronary fistula draining into a persistent left superior vena cava to a markedly dilated and aneurysmal coronary sinus.
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