MDCT evaluation of intramyocardial-sinusoids-coronary artery communications in a neonate with pulmonary atresia and intact ventricular septum

A patient of tetrology of Fallot with complete atresia of the pulmonary outflow tract with ventriculocoronary connections is presented. MDCT imaging revealed left coronary sinus, with a large fistula draining into the free wall of hypoplastic right ventricular cavity with tortuous channel arising from right ventricular outflow, and communicating with proximal limb of the fistula forming a complete loop suggesting a right ventricle-to - left coronary sinus sinusoid.