Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

Abstract

<p> <span style="font-size:10.0pt;"><span style="font-family:Verdana;">We present the case of an unusual complication after percutaneous closure of a giant coronary artery fis-tula. A 76-year-old man with previous admissions due to right heart failure and previous history of atrial fibrillation under acenocumarol, was admitted to our </span><span style="font-family:Verdana;">hospital for new onset of symptoms, characterized </span><span style="font-family:Verdana;">by progressive dyspnoea and peripheral edema. </span></span><span style="font-size:10pt;font-family:Verdana;">Physical examination revealed signs of congestive heart failure </span><span style="font-size:10pt;font-family:Verdana;">and a continuous murmur loudest along the lower sternal border. </span><span style="font-size:10pt;font-family:Verdana;">X-Ray showed cardiomegaly due to right chambers dilatation. Transthoracic echocardiography showed right chambers </span><span style="font-size:10.0pt;"><span style="font-family:Verdana;">pressure and volume overload, with right ventricular enlargement and dysfunction, tricuspid annulus dilatation and severe </span><span style="font-family:Verdana;">tricuspid regurgitation. </span></span><span style="font-size:10pt;font-family:Verdana;">Cardiac catheterization showed </span><span style="font-size:10.0pt;"><span style="font-family:Verdana;">significant elevation of right atrial pressure, as well as significant step-up of oxygen saturation in this chamber. Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm). An Amplatzer</span>^{<span style="font-family:Verdana;">?</span>}<span style="font-family:Verdana;"> PDA was implanted in a distal elbow of the fistula with initailly good results. Anticoagulant therapy was then reinitiated, and a few days later, the patient developed clinical worsening of heart failure and dyspnoea. Echocardiogram showed </span><span style="font-family:Verdana;">significant pericardial effusion. Pleuropericardial </span><span style="font-family:Verdana;">window was then made draining a500 cm</span>^{<span style="font-family:Verdana;">3</span>}<span style="font-family:Verdana;"> of bloody pericardial effusion. The postoperative outcome was excellent, with symptomatic relief and no signs of heart failure.</span></span><b><span style="font-size:10.0pt;"> </span></b><b><span style="font-size:10.0pt;"></span></b> </p