Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

Abstract

Coronary artery fistula is a rare anomaly involving the
coronary artery and a heart chamber or vessel.
Percutaneous intervention has been shown to be
effective and safe in fistulas that are small and nontortuous;
however, it is not an absolute contraindication
in fistulas that are large and tortuous. We report a delayed
diagnosis of a single, large-diameter, tortuous coronary
artery fistula that manifested as myocardial ischaemia due
to the steal phenomenon in a 49 year old male. The
undesirable connection was successfully obliterated by
percutaneous embolisation, followed by an improvement
in symptoms and daily activities. Steal phenomenon is the
fundamental mechanism of myocardial ischaemia in
coronary artery fistula, as confirmed by improvement in
symptoms and coronary artery perfusion following
occlusion of the fistula. Percutaneous catheterization is
safe and effective for coronary artery fistula closure, and
the occlusion site should be precise to achieve complete
occlusion and prevent complications.
Keywords: Coronary, Fistula, Perfusion, Catheterization,
Ischemia,