Percutaneous Closure of Fistulous Tract from Right Coronary Artery to Right Atrium: A Case Report
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Abstract
The coronary artery fistula is a rare form of left to right shunt that can lead to significant hemodynamic consequences if left untreated. The patient, a 10-year-old female, presented with symptoms of increasing dyspnea and palpitations over the past year. Diagnostic imaging, including transthoracic echocardiography and cardiac computed axial tomography, confirmed the presence of a fistulous connection between the right coronary artery and the right atrium. Given the patient’s symptomatic presentation and the risk of complications, a decision was made to proceed with percutaneous closure. Using a catheter-based approach, the fistula was successfully occluded with a Amplatzer Vascular Plug II (AVP II), resulting in the resolution of symptoms and normalization of hemodynamic parameters. This case highlights the efficacy and safety of percutaneous intervention in managing coronary artery fistulas, particularly in pediatric patients, and underscores the importance of early diagnosis and treatment to prevent long-term sequelae.
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References
I. Cai R, Ma X, Zhao X, Xu J, Zhu L, Ku L. CTA analysis of 482 cases of coronary artery fistula: A large-scale imaging study. J Card Surg. 2022;37(7):2172-2181. doi:10.1111/jocs.16500
II. Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol. 2014;203(3):W237-W243. doi:10.2214/AJR.13.11613
III. Cai R, Xu J, Yan C, et al. Imaging characteristics and ECG distribution of coronary fistulas: The first large-scale study. Clin Imaging. 2024;105:110016. doi:10.1016/j.clinimag.2023.110016
IV. Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies. Heart Lung Circ. 2018;27(8):940-951. doi:10.1016/j.hlc.2017.07.014
V. Vitarelli A, De Curtis G, Conde Y, et al. Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography. Am J Med. 2002;113(2):127-133. doi:10.1016/s0002-9343(02)01157-9
VI. Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management [published correction appears in Radiographics. 2018 Nov-Dec;38(7):2214. doi: 10.1148/rg.2018184013]. Radiographics. 2018;38(3):688-703. doi:10.1148/rg.2018170158
VII. Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol. 2014;23(1):1-10. doi:10.1055/s-0033-1349162
VIII. Wu S, Fares M, Zellers TM, Jyothinagaram M, Reddy SRV. Diagnosis and Management of Congenital Coronary Artery Fistulas in Infants and Children. Curr Cardiol Rep. 2023;25(12):1921-1932. doi:10.1007/s11886-023-02007-0
IX. Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol. 2014;23(1):1-10. doi:10.1055/s-0033-1349162
X. Ogden JA. Congenital anomalies of the coronary arteries. Am J Cardiol. 1970;25(4):474-479. doi:10.1016/0002-9149(70)90016-0
XI. Pathak R, Giri S, Hwang I, Alsafwah S. Multiple coronary-cameral fistulas to the left ventricle arising from both coronary arteries. J Community Hosp Intern Med Perspect. 2016;6(3):31190. Published 2016 Jul 6. doi:10.3402/jchimp.v6.31190
XII. Mawatari T, Koshino T, Morishita K, Komatsu K, Abe T. Successful surgical treatment of giant coronary artery aneurysm with fistula. Ann Thorac Surg. 2000;70(4):1394-1397. doi:10.1016/s0003-4975(00)01762-8
XIII. Al-Hijji M, El Sabbagh A, El Hajj S, et al. Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure. JACC Cardiovasc Interv. 2021;14(13):1393-1406. doi:10.1016/j.jcin.2021.02.044