Communicating bilateral coronary artery to pulmonary artery fistula with aneurysm in asymptomatic patient: successful conservative management with selective coil embolization of the aneurysm.

Congenital coronary artery fistula (CAF) is a rare disease. We report a case of a 58-year-old man having a complex coronary to pulmonary artery fistula associated with a large saccular aneurysm originated from the terminal portion of the right coronary artery. An endovascular approach was adopted in order to prevent aneurysmal rupture without need of complete closure of the fistula. We suggest transcatheter embolization as an alternative technique for aneurysmal formation closure in asymptomatic patients with complex CAF complicated with aneurysmal formation if it is not necessary to obtain a complete CAF closure.