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Multiple coronary artery fistulae treated with a single Amplatzer vascular plug: check the back door when the front
Michael A Brown1, David Balzer, John Lasala
1Temple University School of Medicine, 3401 N. Broad St., 945 PP, Philadelphia, PA 19140, USA. michael.brown2@tuhs.temple.edu
Insights
Congenital coronary artery fistulae, rare heart defects, can cause serious issues. This case shows successful percutaneous closure of right coronary to pulmonary artery fistulae in a 56-year-old woman.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Congenital coronary artery fistulae (CCAFs) are uncommon cardiac anomalies.
- CCAFs can lead to severe complications including myocardial ischemia, heart failure, and potentially death.
Observation:
- A 56-year-old woman presented with new-onset chest pain and palpitations.
- Diagnostic imaging revealed a reversible perfusion defect in the anterior left ventricular wall.
- Cardiac catheterization identified multiple fistulous communications between the coronary arteries and the pulmonary artery.
Findings:
- Multiple fistulae originated from the right coronary artery and the left anterior descending coronary artery.
- All fistulae converged into a common ampulla draining into the pulmonary artery.
- Successful percutaneous closure of the fistulae was achieved using an Amplatzer vascular plug.
Implications:
- Percutaneous closure is a viable treatment option for complex coronary artery fistulae.
- Minimally invasive techniques offer effective management for these rare anomalies.
- This case highlights successful intervention for CCAFs presenting with ischemic symptoms.
Abstract:
Congenital coronary artery fistulae are rare anomalies, which can result in myocardial ischemia or infarction, congestive heart failure, fistula rupture, or death. In this report, the authors describe a 56-year-old woman with new onset chest pain and palpitations. Exercise myocardial perfusion imaging was significant for a reversible perfusion defect in the anterior left ventricular wall. Left and right heart catheterization demonstrated multiple fistulous communications between the right coronary and left anterior descending coronary arteries with the pulmonary artery. All fistulae drained into the pulmonary artery by a common ampulla. Closure was achieved via a percutaneous approach using a single Amplatzer vascular plug.
