Giant coronary artery fistula connecting the left coronary sinus with the superior atriocaval junction

A left Valsalva sinus-right atriocaval junction giant congenital fistula was diagnosed in a young man with recent bacterial endocarditis. Surgical closure of the fistula was performed to correct the left-to-right shunt, to reduce the risk of recurrence of endocarditis and to prevent aortic root distortion. Surgery was preferred to percutaneous treatment because of the perceived risk of coronary complications. The dimensions of the residual chamber connected with the aortic root appeared unchanged at the 1-year follow-up echocardiography. Simple closure, with no procedure on the proximal coronary tract of the fistula may offer an effective and definitive correction of giant fistulas.