Author + information
- Received November 16, 2015
- Accepted November 19, 2015
- Published online March 28, 2016.
- aDivision of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
- bDepartment of Cardiothoracic and Vascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
- ↵∗Reprint requests and correspondence:
Dr. Chih-Yuan Fang, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, Taiwan 83301, Republic of China.
Transcatheter closure has emerged as an attractive alternative to traditional surgical closure in patients with suitable anatomy and those without other complex cardiac lesions. This case was a 46-year-old man who experienced intermittent chest pain and palpitation sensations for approximately 10 years. Transthoracic echocardiography showed abnormal flow at the pulmonary root and rim, and abnormal coronary drainage was suspected (Figure 1A). Coronary computed tomography angiography showed large bilateral coronary-to-pulmonary artery fistulae. A large and torturous fistula from the right coronary artery (RCA) to the pulmonary artery (PA) and its orifice was near the ostium of the RCA (Figure 1B). A large and torturous fistula from the left anterior descending coronary artery (LAD) to the PA and its orifice was in the proximal segment of the LAD (Figure 1C). Using a transradial sheathless technique and 7-F guiding catheter, coronary angiography showed a torturous and dilated bilateral coronary to the PA fistulae (Figures 1D and 1E). Furthermore, the guiding catheter was deeply situated into the RCA–PA fistula, and one 12-mm Amplatzer Vascular Plug (St. Jude Medical, Saint Paul, Minnesota) was implanted (Figure 1F). With balloon anchoring, the guiding catheter was inserted into the LAD–PA fistula (Figure 1G), and one 12-mm Amplatzer Vascular Plug was implanted (Figure 1H). The patient could do heavy exercise without symptoms. Coronary fistulae are characterized by anomalous communications between the coronary arteries, cardiac chambers’ coronary sinus, superior vena cava, and PA. In patients with symptomatic and bulky fistulae, potential long-term complications include pulmonary hypertension and heart failure in the cases of significant shunts; infectious endocarditis, thrombosis, or rupture of the fistula; or myocardial ischemia secondary to the theft of myocardial flow (1). In our case, the transradial sheathless technique was introduced for percutaneous closure of coronary artery fistulae.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Dr. Lee contributed equally as the corresponding author.
- Received November 16, 2015.
- Accepted November 19, 2015.
- American College of Cardiology Foundation