Case report: Transcatheter closure of a giant and tortuous right coronary artery to right ventricle fistula in an infant

Abstract

Congenital coronary artery fistulas (CAFs) are an uncommon congenital anomaly. While most patients are asymptomatic, life-threatening events including sudden death, myocardial ischemia, heart failure, infective endocarditis, and rupture of aneurysm may occur. Surgical ligation was once the standard choice of management of CAFs in the past. However, transcatheter closure of CAFs has become an emerging alternative to surgery in patients with suitable anatomy. We reported a 7-month-old infant with a giant and tortuous CAF that originated from the distal right coronary artery and drained into the right ventricle, and was successfully treated by transcatheter closure with an Amplatzer ductus occluder.

Prevalence and characteristics of coronary artery fistulas among 20 259 patients undergoing invasive coronary angiography

“…Although most young patients with CAF are clinically asymptomatic, as CAFs expand over time, the risk of complications, including chronic myocardial ischemia, congestive heart failure, arrhythmias, cardiomyopathy, LV hypertrophy, valvular regurgitation, and pulmonary hypertension, increases [10]. Furthermore, CAFs are associated with infective endocarditis, aneurysmal fistula rupture, and even sudden cardiac death [11][12][13]. The coronary steal phenomenon and volume overload play a decisive role in these processes [6].…”