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[Closure of coronary fistula with the Amplatzer duct occluder system]
Angelo Ramondo1, Giandomenico Tarsia
1U.O. di Emodinamica e Cardiologia Interventistica, Policlinico Universitario, Via Giustiniani, 2 35128 Padova. aramondoit@yahoo.it
Insights
A 54-year-old woman with atrial fibrillation underwent successful percutaneous closure of a coronary artery fistula. This innovative technique using an artery-venous loop ensured the patient became asymptomatic, with no detectable murmur post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Recurrent atrial fibrillation and palpitations in a 54-year-old woman.
- Diagnosis of a coronary artery fistula (CAF) between the right coronary artery and right atrium.
- Aneurysmal dilation of the CAF contributing to symptoms.
Observation:
- Continuous cardiac murmur detected.
- Patient presented with palpitations and atrial fibrillation.
- Anatomical features of the CAF were unusual.
Findings:
- Successful percutaneous closure of the coronary artery fistula.
- Utilized an Amplatzer duct occluder via an artery-venous loop created through femoral access.
- Patient became asymptomatic with resolution of the cardiac murmur at 1-month follow-up.
Implications:
- Demonstrates a peculiar and effective interventional technique for CAF closure.
- Highlights the successful management of symptomatic coronary artery fistulas.
- Provides insights into current guidelines for CAF treatment and percutaneous closure.
Abstract:
We describe a case of a 54-year-old woman with a history of palpitations due to recurrent atrial fibrillation. The diagnosis of a coronary artery fistula between the right coronary artery and right atrium was made after the detection of a continuous cardiac murmur. In view of the patient symptoms and owing to the aneurysmatic dilation of the fistula, she was submitted to percutaneous closure. The anatomic features of the fistula and the closure device used demonstrate the peculiarity of the intervention. An artery-venous loop crossing the coronary fistula was created via the femoral vein and artery; the Amplatzer duct occluder was then advanced through this loop up to the fistula neck and successfully delivered. At 1-month follow-up the patient was totally asymptomatic. Cardiac auscultation revealed that the murmur was no longer detectable. Current guidelines for the treatment of coronary fistulas and on their percutaneous closure are discussed.