Giant Right Coronary Aneurysm to Left Ventricular Fistula

A 59-year-old man was admitted with mild dyspnea on exertion and prior radiographic evidence of cardiac enlargement. His medical history was unremarkable. On physical examination, grade 4 to-and-fro murmur was heard over the left sternal border. ECG showed normal sinus rhythm with left ventricular (LV) hypertrophy. Two-dimensional transthoracic echocardiography in the 3-chamber view showed dilation of the proximal right coronary artery (RCA) (Figure 1A; Movie I). Color Doppler imaging of transthoracic …