Giant septal cavity due to coronary artery fistula and ventricular septal dissection after cardiac surgery

Ventricular septal dissection may rarely result from infectiveendocarditis, myocardial infarction or sinus of Valsalva aneurysmprogression. A rare case that developed in a 66-year-old femaleafter mitral valve replacement for severe mitral regurgitationwith cordal rupture is presented and discussed. It resultedfrom a coronary artery fistula, from a septal branch, to a 6cm wide saccular cystic cavity within the interventricular septum,which was detected by transthoracic echocardiography some monthsafter surgery. Coronary arteries were anatomically normal. Coronaryangiography was helpful to clarify the origin of the fistula.Later on the patient developed heart failure and atrial fibrillation,but she refused any further intervention. She has been followedup for more than 7 years and is presently stable on medicaltherapy. A review of the peculiar aspects of the case is done and themost relevant aspects and images are presented and discussed.