Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child

Abstract

Coronary artery fistulas (CAFs) are rare cardiac anomalies characterized by an abnormal connection between the coronary arteries and either a cardiac chamber or a large thoracic vessel. While the majority of CAF cases are asymptomatic, serious cardiac complications can occur, especially with moderate to large fistulas. We describe a case of a large-sized left coronary artery (LCA) fistula in an asymptomatic 11-year-old who was referred for cardiac evaluation due to a systolic murmur. An echocardiogram revealed a hemodynamically significant fistula arising from the LCA draining into the right ventricle. Diagnostic catheterization confirmed the origin and draining site of the fistula, along with aneurysmal dilation at the end of the fistula. The fistula was successfully closed percutaneously using a two-coil occlusive device, with no complication observed.

Keywords: asymptomatic patient; cardiac cta; cardiac murmur; child; coronary artery fistula (caf); transcatheter closure.

Figure 1. Computed tomography angiography three-dimensional images demonstrate fistula origin from the mid-left anterior descending artery (yellow arrow), which bifurcates into two branches (white arrow) and terminates near the base of the right ventricle outflow (blue arrow).