Percutaneous Closure of a Diagonal Artery to Pulmonary Artery Fistula
Luai Madanat1, Robert D Safian1, Marina Maraskine1
1Department of Cardiovascular Medicine, William Beaumont University Hospital, Corewell Health East, Royal Oak, Michigan, USA.
Insights
Coronary artery fistulas, rare heart vessel anomalies, can cause angina. Successful coil embolization of a diagonal artery to pulmonary artery fistula resolved symptoms in a symptomatic patient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Anomalies
Background:
- Coronary artery fistulas are uncommon congenital or acquired abnormalities.
- They are often asymptomatic and discovered incidentally during cardiac imaging.
- Symptomatic presentations, though rare, can include angina and ischemia.
Purpose of the Study:
- To report a case of a symptomatic patient with a coronary artery fistula.
- To illustrate the diagnostic utility of coronary computed tomographic angiography.
- To describe the successful interventional management of the fistula.
Main Methods:
- Clinical case presentation of a symptomatic patient.
- Diagnostic workup including exercise stress testing, coronary angiography, and coronary computed tomographic angiography.
- Successful percutaneous closure using coil embolization.
Main Results:
- Coronary angiography identified a fistula between the proximal diagonal artery and the main pulmonary artery.
- Coronary computed tomographic angiography provided detailed anatomical information for planning.
- Coil embolization successfully occluded the fistula.
Conclusions:
- Coronary artery fistulas can present with significant symptoms like angina.
- Multimodality imaging, including CT angiography, is crucial for diagnosis and planning.
- Percutaneous coil embolization is an effective treatment for symptomatic coronary artery fistulas.
Abstract:
Coronary artery fistulas are uncommon anomalies that are typically asymptomatic and incidentally identified through coronary angiography or computed tomographic angiography. In this clinical vignette, we report a symptomatic patient with exertional angina and anterior ischemia on exercise stress testing. Coronary angiography revealed a fistula between the proximal diagonal artery and the main pulmonary artery. Coronary computed tomographic angiography provided precise anatomical detail, facilitating procedural planning. The patient underwent successful coil embolization of the fistula, resulting in complete resolution of angina.
