Percutaneous closure of the coronary artery-pulmonary artery fistula in a patient with apical hypertrophic cardiomyopathy

Abstract

A fifty-four-year-old female patient was admitted to our unit with exertional chest pain of six months duration. Transthoracic echocardiography showed apical hypertrophy. Upon further investigation, cardiac magnetic resonance imaging revealed apical hypertrophic cardiomyopathy. The patient underwent myocardial perfusion scintigraphy which showed anterior ischemia. Coronary angiography revealed an arteriovenous fistula (AVF) from the left anterior descending artery to the pulmonary artery. The patient's chest pain was attributed to a coronary steal syndrome secondary to the coronary AVF. The AVF fistula was closed with a coil and the patient's chest pain improved. In conclusion, coronary steal syndrome may lead to myocardial ischemia in patients with a coronary AVF.

Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome

“…The pursue behind Interventions for coronary fistula with objective evidence of myocardial ischemia and steel syndrome is to provide long-term event-free survival either by trasnscatheter interventions (Coiling, Embolisation, Occluder Devices) or surgical closure utilizing external placation on the beating heart or by intracardiac closure using cardiopulmonary bypass with or without cardiac arrest [ 7 , 8 ]. A paradoxical scenario is seen in our patient as the first presentation of this occluded coronary fistula was an ongoing ischemia in the setting of acute coronary syndrome, so the dilemma was whether to open or not!…”