Successful Transcatheter Patent Ductus Arteriosus Occluder Embolization of a Congenital Left Coronary Artery Aneurysm and Fistulas Draining into the Right Atrium

Abstract

Coronary artery aneurysms and fistulas are very rare congenital anomalies. They occur in 0.2%-0.4% of all congenital heart diseases. In this article, we report a case of a 39-year-old girl with a left coronary artery aneurysm and fistula draining into the right atrium. An intervention is successfully achieved by transcatheter occluder embolization using a patent ductus arteriosus (PDA) occluder.Keywords: congenital coronary artery aneurysm, coronary artery-right atrium fistula, interventional occlusion of fistula, PDA occluder and myocardial rupture.3) Transcatheter closure of coronary artery fistulas has emerged as a successful alternative to surgery. We describe a case of percutaneous closure of a fistula developed between the left circumflex and the right atrium. Technical aspects and potential complications of this rare procedure are detailed. Case ReportA 39-year-old woman was referred to our institution for evaluation of a left coronary artery aneurysm with fistulous communication to the right atrium. The patient initially presented with shortness of breath, a heart rate of 62 beats/min and blood pressure of 124/72 mmHg. A continuous murmur (Levine 3/6) was heard over the precordial region. A chest X-ray showed a cardiothoracic ratio of 65% and the electrocardiogram (ECG) had a normal sinus rhythm with no significant ST-T changes. Echocardiography revealed an enlarged right ventricle and right atrium without any valvular defects. ColorDoppler examination visualized a left coronary aneurysm (left main trunk and left circumflex artery) and a possible communication with the right atrium, and 56.14% left to right shunt was found at the level of the right atrium. A contrast-enhanced 64-slice multidetector computed

Giant aneurysm of the left main coronary artery with fistulous communication to the right atrium

“…The proximal and distal fistula was closed by running suture which did not affect the coronary flow and avoided CABG surgery compared with the approach reported by Margux and colleagues [6]. Trans-catheter occlusion with embolization reported by Wang et al [7] is another therapeutic choice for this disease, but the AR in our patient made the trans-catheter occlusion procedure unsuitable.…”

Presentation and Management of a Giant Coronary Artery Aneurysm with a Fistula to the Right Ventricle

“…Although rare, concomitant CAF and CAA have been treated surgically before [ 6 ]. The repair is done by closing the fistula and then forming a bypass route using a vein graft in order to supply the distal vasculature [ 6 , 7 ]. However, due to both the giant nature of the aneurysm and the diffuse ectasia of the entire LAD in this patient, the best treatment plan becomes more difficult to determine [ 6 ].…”