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Conservatively Managed Iatrogenic Coronary Fistula to the Coronary Sinus During Primary Percutaneous Intervention
Tarek Mahdy1, Mahmoud Khedr1, Edward Hoey1
1University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Insights
Iatrogenic coronary fistula, a rare complication of percutaneous coronary intervention, can occur from guidewire or balloon issues. Multimodality imaging guides individualized treatment for this coronary artery anomaly.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Iatrogenic coronary fistula is an uncommon complication arising from percutaneous coronary intervention (PCI).
- This condition involves an abnormal connection between a coronary artery and a cardiac chamber or vessel.
Background:
Iatrogenic coronary fistula is a rare complication during percutaneous coronary intervention.
Case Summary:
A 69-year-old woman presented with inferior ST-segment elevation myocardial infarction for which she underwent a primary percutaneous coronary intervention. During the procedure, a communication was noted between the distal right coronary artery and the coronary sinus. The patient was hemodynamically stable. She underwent a computed tomography coronary angiography and echocardiography which confirmed the diagnosis of coronary fistula. She underwent staged procedure for percutaneous coronary intervention, and the fistula flow diminished. The patient remained under follow-up and regular imaging assessment with no concerning signs or symptoms.
Discussion:
Despite its rarity, iatrogenic coronary fistula during intervention can occur due to intimal balloon inflation, guidewire perforation, and artery-balloon size mismatch.
Take-Home Messages:
The appropriate treatment for iatrogenic coronary fistula should be determined on an individual-specific basis. A detailed multimodality imaging assessment is required to determine the fistula route and its hemodynamic effect.
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