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Published on: November 4, 2021
Percutaneous, catheter-based coil embolization of coronary fistula: determination of hemodynamic relevance
Olaf Oldenburg1, Thomas Philipp, Michael Forsting
1Department of Cardiology, Division of Internal Medicine, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany. olaf.oldenburg@uni-essen.de
Insights
A patient with coronary artery disease and a fistula between the left anterior descending artery and pulmonary artery underwent successful coil embolization. This treatment normalized cardiac output and coronary blood flow, resolving chest pain.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery fistulas are rare anomalies that can cause significant hemodynamic disturbances.
- A 55-year-old male presented with angina-like chest pain, initially suspected to be due to coronary artery disease.
Observation:
- Coronary angiography revealed a large fistula connecting the left anterior descending artery to the pulmonary artery, without significant epicardial stenosis.
- Hemodynamic assessment showed a hyperdynamic cardiac output (17 L/min) and elevated coronary blood flow (140 mL/min) with a 58% shunt fraction.
Findings:
- Percutaneous coil embolization effectively occluded the coronary fistula.
- Post-embolization, cardiac output (9 L/min) and coronary blood flow (48 mL/min) normalized.
- The patient experienced complete resolution of symptoms and showed no signs of myocardial ischemia on follow-up stress tests.
Implications:
- Catheter-based coil embolization is a safe and effective treatment for coronary artery fistulas causing significant shunting.
- Successful fistula closure can rapidly restore normal cardiac hemodynamics and alleviate ischemic symptoms.
- This case highlights the importance of considering coronary fistulas in the differential diagnosis of angina with non-obstructive coronary artery disease.
Abstract:
A 55-year-old male with angina-like chest pain and positive thallium-scintigraphy was admitted to our hospital. Cardiac catheterization was performed for suspected coronary artery disease. The coronary angiogram showed no significant epicardial stenosis, but a large coronary fistula, connecting the left anterior descending artery with the pulmonary artery. Swan-Ganz catheter measurements, intracoronary Doppler, and quantitative coronary angiography were used to determine cardiac output, coronary blood flow, and coronary-to-pulmonary artery shunt fraction. These measurements showed a hyperdynamic cardiac output of 17 L/min, a coronary blood flow of 140 mL/min in the left anterior descending coronary artery with an estimated shunt fraction of 58% into the pulmonary circulation. Percutaneous, catheter-based coil embolization was performed to occlude the fistula. After embolization of one coil, coronary angiography showed the fistula's stump only. Cardiac output (9 L/min) and coronary blood flow (48 mL/min) were almost normalized. The patient was discharged from the hospital the day after the procedure. After a 6-month follow-up, there were still no complaints, angina-like symptoms or signs of myocardial ischemia in stress tests.
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