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Transcatheter Coil Embolization of Iatrogenic Aorto-Right Atrial Fistula
Muhammad Umer Awan1, Kulwant Bath1, Nilarun Chowdhuri1
1University of South Alabama, Mobile, AL, USA.
Insights
Coronary artery fistula (CAF) is a rare complication after coronary artery bypass grafting (CABG). Coil embolization successfully treated a patient with an aorto-right atrial fistula, resolving persistent angina when medical management failed.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Complications
Background:
- Coronary artery fistula (CAF) is an uncommon complication post-coronary artery bypass grafting (CABG).
- At least 50% of CAFs are asymptomatic, making true incidence difficult to ascertain.
- CAFs can be congenital or acquired due to trauma, infection, or iatrogenic injury.
Observation:
- A 58-year-old man presented with persistent angina following CABG.
- The patient had an iatrogenic aorto-right atrial fistula due to inadvertent saphenous vein grafting (SVG) to a right coronary vein.
- Medical management failed to alleviate the symptoms.
Findings:
- A large, hemodynamically significant aorto-right atrial fistula was identified.
- Successful obliteration of the fistula was achieved through coil embolization.
- The patient experienced complete resolution of angina symptoms post-procedure.
Implications:
- Coil embolization is an effective treatment for hemodynamically significant iatrogenic CAFs unresponsive to medical therapy.
- This case highlights the importance of recognizing and managing iatrogenic CAFs after CABG.
- Successful fistula obliteration can lead to significant symptom relief and improved patient outcomes.
Abstract:
Coronary artery fistula (CAF) is a rare complication following coronary artery bypass grafting (CABG). True incidence is unknown, as at least 50% are asymptomatic. CAF can be either congenital or acquired. Congenital CAF is either an isolated finding or seen with other congenital cardiac anomalies or structural heart defects. Acquired CAF is seen in relation with trauma, infection, or iatrogenic injury. We report a rare case of a 58-year-old man with iatrogenic aorto-right atrial fistula following inadvertent saphenous vein grafting (SVG) implantation to a right coronary vein with persistent angina following CABG and resolution of symptoms following successful obliteration of large, hemodynamically significant, fistulae by coil embolization when medical management failed.
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