Stent-graft exclusion of multiple symptomatic coronary artery fistulae

Abstract

Coronary artery fistulae may be congenital or acquired abnormalities in which blood is shunted into a cardiac chamber, great vessel, or other structure, bypassing the myocardial capillary network. Patients with coronary artery fistulae may present with dyspnea, congestive heart failure, angina, endocarditis, arrhythmias, or myocardial infarction. Symptomatic patients must be treated in order to prevent such complications as sudden death or myocardial infarction. Surgery is the gold standard for closure of these lesions; however, an increasing number of reports have shown that percutaneous closure may be a safe and effective alternative. We report the successful percutaneous exclusion of multiple coronary artery-to-pulmonary artery fistulae by means of several balloon-expandable stent-grafts in a patient who had a history of coronary artery bypass surgery and symptoms of congestive heart failure.

Fig. 1 Selected coronary angiography shows 2 large fistulae from the left anterior descending artery (LAD) to the pulmonary artery A) before stenting, B–E) during the procedure, and F) after deployment of 2 stents.

Fig. 2 Large right coronary artery-to-pulmonary artery fistula clearly shown on selected coronary angiography A) before stenting, B) during the procedure, and C) after deployment of a stent-graft. RAO = right anterior oblique; RCA = right coronary artery