Right Coronary Artery to Coronary Sinus Fistula: A Rare Problem With an Elegant Solution

This case report describes a 62-year-old man with exertional dyspnea due to a massive, serpentine right coronary artery aneurysm with fistulization to the coronary sinus, causing significant left-to-right shunt and right heart dilation. Given the large size and complex anatomy, transcatheter closure was deemed unsuitable. The team performed complete aneurysm unroofing, fistula ligation, and comprehensive revascularization using a reversed saphenous vein graft to construct a neo–right coronary artery with eight sequential bypasses. Postoperative imaging confirmed patent grafts and normalized anatomy. At one-year post-surgery, the patient remained asymptomatic.