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The images presented here are from a 44-year-old asymptomatic man. At age 36 years, he experienced nonsustained atrial fibrillation. A year later, a transthoracic echocardiogram disclosed an enlarged left ventricle (diastolic dimension, 7.4 cm; ejection fraction, 56%) and a very large coronary sinus with Doppler color flow evidence of diastolic and systolic turbulence consistent with entry of a coronary arteriovenous fistula. Current selective coronary angiography visualized dilated circumflex and right coronary arteries, both of which entered an aneurysmal coronary sinus. An MRI during breath-hold acquisition further delineated the enlarged coronary sinus into which the circumflex and right coronary arteries drained (Figure 1⇓). A 3-dimensional (3D) image …

Arteriovenous Fistulas of the Circumflex and Right Coronary Arteries With Drainage Into an Aneurysmal Coronary Sinus