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Percutaneous iatrogenic coronary fistula closure in heart transplant recipient
Giuseppe Bruschi1, Jacopo Oreglia, Paola Colombo
1A De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
Insights
A large coronary artery fistula between the left anterior descending artery and the right ventricle was identified post-heart transplant. This fistula was successfully treated with a covered stent when ischemic symptoms developed 8 years later.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Transplantation Medicine
Background:
- Ischemic cardiomyopathy necessitates orthotopic heart transplantation for end-stage heart failure.
- Post-transplant monitoring includes routine coronary angiography to assess graft health and detect complications.
Observation:
- A significant coronary artery fistula, originating from the left anterior descending artery and draining into the right ventricle, was incidentally discovered one year after heart transplantation.
- The patient remained asymptomatic for eight years following the initial diagnosis of the fistula.
Findings:
- The coronary artery fistula was successfully occluded percutaneously using a covered stent.
- Percutaneous closure effectively resolved the patient's subsequent ischemic symptoms.
Implications:
- Coronary artery fistulas are rare but significant complications following orthotopic heart transplantation.
- Percutaneous closure with covered stents offers a viable and effective treatment option for symptomatic coronary artery fistulas in heart transplant recipients.
Abstract:
A 61-year-old man with ischemic cardiomyopathy underwent orthotopic heart transplantation. On routine coronary angiography 1 year later, a huge fistula was seen between the left anterior descending coronary artery and the right ventricle. When the patient developed symptoms of ischemia 8 years later, the fistula was successfully closed percutaneously, using a covered stent.
