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Case Report: Coronary-Pulmonary Fistula Closure by Percutaneous Approach: Learning From Mistakes
Vladimir Rubimbura1,2, Grégoire Girod1,3, Alain Delabays1,2
1Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland.
Insights
Coronary-pulmonary artery fistulas (CPAF) can be closed percutaneously. Combining vascular plugs and coils offers a successful treatment for significant shunts, resolving symptoms like dyspnea.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Coronary-pulmonary artery fistulas (CPAF) are rare congenital vascular anomalies.
- Significant left-right shunts necessitate intervention, often surgical or percutaneous.
Observation:
- A patient presented with dyspnea due to a significant left-right shunt from CPAF.
- An initial percutaneous attempt using a vascular plug failed due to embolization, requiring retrieval.
Findings:
- A second percutaneous approach successfully closed the CPAF.
- This involved deploying coils followed by a vascular plug, achieving total fistula closure.
Implications:
- The combined use of coils and vascular plugs enhances the success rate for percutaneous CPAF closure.
- This approach offers a viable alternative for symptomatic patients with significant shunts.
Abstract:
Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.
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