Congenital Right Coronary Artery Fistula Causing an Aortic Steal: A Rare Anatomic Abnormality and a Review of the Literature

Coronary artery fistulas are an uncommon anatomic anomaly with variable presentations. We present an asymptomatic seven-month-old black male with a large coronary artery fistula draining into the right ventricle, causing an aortic backflow on diastole. Despite this prominent alternative drainage pathway, coronary fistulas are commonly an incidental finding and, as in this case, may not require intervention. Through an assessment of previous literature, we recommend providers maintain an elevated index of suspicion for coronary artery fistulas in young persons who present with signs of heart failure, and that the decision to treat should be determined based on the patient's symptoms, age at presentation, and imaging finding severity