Early and late presentation of coronary artery fistula: a possible natural progression?

Area of Science:

• Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Coronary artery fistulas, abnormal connections between coronary arteries and heart chambers, can lead to significant cardiovascular complications.
• Left main coronary artery to right atrium (LM-RA) fistulas are a rare but serious type of coronary artery fistula.
• Transcatheter closure offers a minimally invasive treatment option for coronary artery fistulas.

Observation:

• Two patients, aged 10 and 43 years, presented with LM-RA fistulas.
• Both patients underwent successful transcatheter closure of their fistulas.
• The older patient, with a larger fistula, experienced more symptoms and a complex post-procedure course.

Findings:

• Transcatheter closure is a viable and effective treatment for LM-RA fistulas.
• Fistula size and patient age may influence procedural complexity and outcomes.
• Successful closure was achieved in both pediatric and adult patients.

Implications:

• Early consideration for transcatheter closure of medium to large LM-RA fistulas, even in younger patients, is crucial.
• Timely intervention can potentially minimize the risk of future complications associated with untreated coronary artery fistulas.
• This approach may improve long-term outcomes and reduce morbidity in patients with LM-RA fistulas.