This is the case report of a young man examined for presyncope and diagnosed to have coronary artery fistula between the right coronary artery and superior vena cava, with its subsequent successful catheter-based closure using an Amplatzer Vascular Plug II 6 mm occluder. Coronary artery fistulas are a congenital anomaly allowing for direct communication between the coronary artery and large vessels or some cardiac chambers bypassing the capillary bed.
While asymptomatic for many years, the patient starts showing symptoms secondary to right or left ventricular overload. Although most commonly managed by surgical closure, the less invasive catheter-based procedure has recently been increasingly used.