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Multidisciplinary Approach to Closure of a Late-Presenting Large Coronary Artery Fistula
Sarah Harirforoosh1, Raveendra Morchi2, Gira Morchi3
1Mary & Steve Wen Cardiovascular Division, Department of Medicine, University of California-Irvine, Orange, California, USA. Electronic address: https://twitter.com/sarahharir.
Insights
Coronary artery fistulas (CAFs) are rare congenital conditions. This case demonstrates successful coil embolization closure of a large CAF in an active bodybuilder, preserving his lifestyle.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Coronary artery fistulas (CAFs) are uncommon congenital arteriovenous malformations.
- Management strategies include surveillance or intervention based on patient factors.
Observation:
- A 63-year-old male bodybuilder presented with tachyarrhythmia and received defibrillator shocks.
- Coronary angiography identified a large coronary fistula from the left main/left circumflex artery to the superior vena cava.
Findings:
- Intervention was pursued due to concerns of coronary steal syndrome.
- A multidisciplinary, nonsurgical approach using coil embolization successfully closed the fistula.
- A subcutaneous implantable defibrillator was placed for secondary prevention.
Implications:
- This case underscores the importance of identifying appropriate indications for CAF closure.
- Multidisciplinary collaboration and knowledge of imaging and interventional techniques are crucial for effective treatment discussions.
Background:
Coronary artery fistulas (CAFs) are rare congenital arteriovenous malformations that are usually incidentally discovered. Once a CAF is confirmed, the management involves surveillance or a transcatheter or surgical intervention for certain patient populations as highlighted herein.
Case Summary:
A 63-year-old male bodybuilder presented with lightheadedness and wide complex tachyarrhythmia requiring 2 defibrillator shocks. Coronary angiography revealed a large tortuous coronary fistula from the left main coronary artery/left circumflex artery emptying into the superior vena cava. Due to concerns for coronary steal, a decision was made to intervene. A nonsurgical multidisciplinary approach, utilizing coil embolization, was planned for fistula closure to preserve the patient's active lifestyle. In addition, a subcutaneous implantable defibrillator was inserted for secondary prevention.
Discussion:
This case highlights the importance of identifying indications for CAF closure. Knowledge of available imaging modalities and interventional approaches allows for the productive discussion of treatment options across multiple specialties.
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