Treatment of multiple residual complex coronary to right ventricular fistulae with covered stents following previous coil embolization

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Congenital coronary artery fistulae (CCAF) are abnormal connections between coronary arteries and heart chambers.
• CCAF can be isolated or associated with complex congenital heart disease (CHD).
• Treatment options include surgery, coil embolization, and covered stent deployment.

Observation:

• A 20-year-old patient presented with complex congenital heart lesions and multiple persistent sinusoidal coronary-to-right ventricle fistulae.
• Previous coil embolization in childhood had failed to close the fistulous communications.
• The multiple nature of the fistulae made further coil or device embolization unlikely to succeed.

Findings:

• Covered stents were successfully deployed across the previously coiled segments of the coronary artery.
• The patient experienced significant symptom improvement following the intervention.
• Follow-up at nine months demonstrated an excellent clinical outcome.

Implications:

• Covered stent deployment is a viable and effective treatment for complex, persistent congenital coronary artery fistulae.
• This approach offers a valuable alternative when traditional embolization techniques are insufficient.
• Successful management of CCAF can lead to significant clinical improvement in patients with complex CHD.