Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child
Asmaa Semrin1, Jose Colon Cortes2, Mark Vranicar3
1Pediatrics, Augusta University Medical College of Georgia, Augusta, USA.
Insights
A rare coronary artery fistula in an 11-year-old was successfully closed using coils. This case highlights percutaneous closure for large coronary artery fistulas, preventing potential cardiac complications.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Coronary artery fistulas (CAFs) are uncommon congenital heart defects involving abnormal connections between coronary arteries and heart chambers or vessels.
- While often asymptomatic, moderate to large CAFs can lead to severe cardiac issues.
- Early detection and intervention are crucial for managing potential complications.
Observation:
- An asymptomatic 11-year-old presented with a systolic murmur, leading to cardiac evaluation.
- Echocardiography identified a significant fistula originating from the left coronary artery (LCA) draining into the right ventricle.
- Diagnostic catheterization confirmed the LCA fistula and associated aneurysmal dilation.
Findings:
- The large LCA fistula was successfully treated with percutaneous closure using a two-coil occlusive device.
- The procedure was performed without any observed complications.
- This demonstrates the efficacy of minimally invasive techniques for treating complex CAFs.
Implications:
- Percutaneous closure is a safe and effective treatment option for large coronary artery fistulas in pediatric patients.
- Successful closure can prevent serious cardiac complications associated with untreated CAFs.
- This case contributes to the understanding of managing rare congenital heart anomalies in children.
Abstract:
Coronary artery fistulas (CAFs) are rare cardiac anomalies characterized by an abnormal connection between the coronary arteries and either a cardiac chamber or a large thoracic vessel. While the majority of CAF cases are asymptomatic, serious cardiac complications can occur, especially with moderate to large fistulas. We describe a case of a large-sized left coronary artery (LCA) fistula in an asymptomatic 11-year-old who was referred for cardiac evaluation due to a systolic murmur. An echocardiogram revealed a hemodynamically significant fistula arising from the LCA draining into the right ventricle. Diagnostic catheterization confirmed the origin and draining site of the fistula, along with aneurysmal dilation at the end of the fistula. The fistula was successfully closed percutaneously using a two-coil occlusive device, with no complication observed.
