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Treatment of a large congenital coronary fistula with coil embolization
1Department of Radiology, Orebro Medical Center Hospital, Sweden.
Insights
A congenital coronary fistula was successfully treated using transcatheter coil embolization. This minimally invasive technique effectively closed the large fistula, resolving the patient's symptoms.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Congenital coronary fistulas can cause significant symptoms like dyspnea and chest pain.
- Diagnostic workup for such conditions can be complex, involving multiple imaging modalities.
- Traditional treatment options may be limited for large or complex fistulas.
Observation:
- A 77-year-old woman presented with progressive dyspnea and chest pain.
- Standard exercise tests and dobutamine stress echocardiography were normal.
- Cardiac catheterization revealed normal right-sided pressures but identified a large coronary fistula.
Findings:
- A congenital coronary fistula (3-4 mm diameter) originated from the left anterior descending artery and drained into the pulmonary artery.
- There was no significant increase in pulmonary artery oxygen saturation.
- Transcatheter coil embolization successfully occluded the fistula distally.
Implications:
- Transcatheter coil embolization is a feasible and effective treatment for large congenital coronary fistulas.
- This minimally invasive approach offers a viable alternative to surgical intervention.
- Successful embolization led to rapid cessation of fistula flow and symptom resolution.
Abstract:
A 77-year-old woman suffering from progressive dyspnea and chest pain for 2 1/2 years was admitted to hospital. There were no ECG changes at exercise test and a dobutamine stress echocardiography was normal. At catheterization, right-sided pressures were within normal limits. Coronary angiography revealed a congenital coronary fistula, 3-4 mm in diameter, from the left anterior descending artery to the proximal pulmonary artery. There was no significant rise in blood oxygen saturation in the pulmonary artery. Transcatheter coil embolization was performed in the distal part of the tortuous fistula. Flow ceased within minutes, demonstrating the feasibility and efficacy of this technique for treating large fistulas.