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Stent-graft exclusion of multiple symptomatic coronary artery fistulae
Seyed Ebrahim Kassaian1, Mehran Mahmoodian, Mojtaba Salarifar
1Department of Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. ekassaian@yahoo.com
Insights
Coronary artery fistulae, abnormal connections bypassing heart capillaries, can cause serious symptoms. Percutaneous closure using stent-grafts offers a safe and effective treatment alternative to surgery for these complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulae (CAF) are abnormal communications diverting blood from coronary arteries.
- CAFs can lead to significant cardiovascular complications including heart failure, angina, and myocardial infarction.
- Surgical intervention is the traditional treatment, but minimally invasive options are increasingly explored.
Observation:
- A patient with a history of coronary artery bypass surgery presented with symptoms of congestive heart failure.
- The patient was diagnosed with multiple coronary artery-to-pulmonary artery fistulae.
- These fistulae bypassed the myocardial capillary network, impacting cardiac function.
Findings:
- Successful percutaneous closure of multiple coronary artery-to-pulmonary artery fistulae was achieved.
- The intervention utilized several balloon-expandable stent-grafts.
- This minimally invasive approach effectively excluded the fistulae.
Implications:
- Percutaneous closure of complex CAFs is a viable and safe alternative to surgery.
- Stent-grafts provide an effective method for treating coronary artery fistulae.
- This approach may prevent serious complications and improve patient outcomes in selected cases.
Abstract:
Coronary artery fistulae may be congenital or acquired abnormalities in which blood is shunted into a cardiac chamber, great vessel, or other structure, bypassing the myocardial capillary network. Patients with coronary artery fistulae may present with dyspnea, congestive heart failure, angina, endocarditis, arrhythmias, or myocardial infarction. Symptomatic patients must be treated in order to prevent such complications as sudden death or myocardial infarction. Surgery is the gold standard for closure of these lesions; however, an increasing number of reports have shown that percutaneous closure may be a safe and effective alternative. We report the successful percutaneous exclusion of multiple coronary artery-to-pulmonary artery fistulae by means of several balloon-expandable stent-grafts in a patient who had a history of coronary artery bypass surgery and symptoms of congestive heart failure.
