Right coronary artery to coronary sinus fistula repair with the use of robotic-enhanced thoracoscopy

Background: Incidence of coronary fistula has not been reported clearly yet, but angiographic prevalence estimation is 0, 2 %. The Right Coronary Artery (RCA) is mainly involved and is preferentially connected to the right ventricle, right atrium and pulmonary vein. The Coronary Sinus (CS) is the site of drainage in only 7% of cases. We report the preoperative imaging of this lesion, and its repair through a successful robotic-enhanced right thoracoscopical approach. Case report: A 49-year old woman presented with a recent history of grade I-II dyspnoea and a systolodiastolic cardiac murmur. Doppler echocardiography revealed the presence of a right coronary artery-to-coronary sinus fistula and this diagnosis was confirmed by cardiac CT and coronary angiography. The treatment of this uncommon lesion usually consists into transcatheter closure or surgical repair through a median sternotomy. Conclusion: Robotic-enhanced thoracoscopy as a new approach for the surgical treatment of right coronary fistula is efficient, feasible, safe and less invasive than the conventional sternotomy. Keywords: Congenital heart disease, CABG new technology, Robotics, Fistula