A five-chambered heart: rare coronary artery anomaly with fistula draining into a separate interventricular cavity.

The combination of color flow Doppler imaging, contrast echocardiography, magnetic resonance imaging, and coronary arteriography documented the presence of a right coronary artery fistula that opened into a separate cavity in the anterior part of the interventricular septum in a 32-year-old man. Although a traumatic origin could not be excluded, the abnormality was most likely a congenital anomaly. Because there were no significant symptoms and no signs of hemodynamic burden on the heart, a conservative management was decided and no complications occurred during 3 years of follow-up. So far the literature includes only one similar case described by autopsy findings.