Percutaneous closure of a coronary fistula

Pawel Buszman, MDPawel Buszman, MD

Silesian Medical SchoolSilesian Medical School

Katowice, PolandKatowice, Poland

Clinical data:

Male,40 year oldMale,40 year old Angina, CCS class 3Angina, CCS class 3 Risk factors: BMI 32, arterial hypertensionRisk factors: BMI 32, arterial hypertension Tredmil stress test: 6 min., 7 METs, limited Tredmil stress test: 6 min., 7 METs, limited

by angina and ST changes in precordial by angina and ST changes in precordial leadsleads

Chest X-Ray suggesting L to R shuntChest X-Ray suggesting L to R shunt On auscultation: systolic murmur over PAOn auscultation: systolic murmur over PA

Clinical data

UKG:UKG:

LVEDD/LVESDLVEDD/LVESD 52/38 mm52/38 mmLVEFLVEF 55%55%RVRV 33 mm33 mm

Normal LV and valves function, no IVS or Normal LV and valves function, no IVS or IAS defectIAS defect

Coronary angiography

LAD-PAfistula

LAD-PAfistula

S1IMA

LCA: RAO30/Caud15 LCA: left lateral view

Should the fistula be treated?

Clinical symptomsClinical symptoms Myocardial ischaemia on stress testMyocardial ischaemia on stress test Features of L-R shunt on chest X-RayFeatures of L-R shunt on chest X-Ray

The answer is: YES

Percutaneous closure of the coronary fistula

Jomed coronary graft stenton balloon 4.0 mm

LCA: RAO30/Caud15post stent-graft implantation

6 month follow-up

No anginaNo angina Tredmil stress test:Tredmil stress test:

85% of MHR, 10 METS, no ischemia on 85% of MHR, 10 METS, no ischemia on ECG, ECG,

A control angio: no restenosisA control angio: no restenosis

6 month coronary angiography

LCA: RAO30/Caud156 month follow-up

Stented segment Stented segment

LCA: LL90

Conclusions

Coronary fistula can be completely closed Coronary fistula can be completely closed with a graft stent.with a graft stent.

Beacause of the risk of in stent restenosis a Beacause of the risk of in stent restenosis a control coronary angiography should be control coronary angiography should be taken after 6 month.taken after 6 month.