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Case Reports
. 2025 Sep 17;30(28):105013.
doi: 10.1016/j.jaccas.2025.105013.

Percutaneous Closure of a Large Right Coronary Artery Fistula Draining Into the Superior Vena Cava

Mickael Hermano Ogama  1 , Pablo Tomé Teixeirense  2 , Marden A Tebet  1 , Vinícius Esteves  1 , João Ricardo Antunes  1 , Ariane Binoti Pacheco  3 , Igor Ramon Batista  1 , Sérgio Kreimer  1 , Eduardo Moreira  1
Affiliations
Case Reports

Percutaneous Closure of a Large Right Coronary Artery Fistula Draining Into the Superior Vena Cava

Mickael Hermano Ogama et al. JACC Case Rep. .

Abstract

Background: Coronary fistulas exhibit considerable anatomic diversity, resulting in unique implications and treatment approaches.

Case summary: A 38-year-old man with palpitations, chest pain, and dizziness was diagnosed with a large coronary fistula connecting the proximal right coronary artery to the superior vena cava. Percutaneous occlusion was chosen to alleviate symptoms and elevated right-sided filling pressures. After angiotomographic and angiographic evaluation, vascular plugs were selected because of the large caliber of the fistula.

Discussion: This case highlights that although rare, coronary fistulas can cause significant clinical repercussions, and their management must be based on a comprehensive assessment of both clinical and anatomic factors.

Take-home messages: Coronary fistulas can cause significant symptoms and clinical repercussions, which warrant an evaluation for occlusion. The management of coronary fistulas requires a multidisciplinary heart team discussion to select the optimal treatment based on precise clinical and anatomic considerations.

Keywords: cardiac catheterization; congenital heart disease; coronary fistula.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
3-Dimensional Reconstruction of the Angiotomography Using the Open Software 3D Slicer The tortuosity of the fistula originating from the proximal third of the right coronary artery and terminating in the superior vena cava is observable (yellow arrow).
Figure 2
Figure 2
Percutaneous Occlusion Through Plugs in the Arterial and Venous Ends of the Coronary Fistula (A) Initial injection demonstrating a large fistula between the proximal third of the right coronary artery and the superior vena cava. (B) Passage of a 0.014-in × 300-cm guidewire through the fistula with the aid of a microcatheter. (C) Formation of an arteriovenous loop with the aid of a snare. (D) Advancement of the guide catheter through the venous route with the aid of balloon-assisted tracking. (E) An 8-mm AVP 4 vascular plug released at the venous end and a (F) 12-mm AVP II vascular plug released at the arterial end. (G) The final injection demonstrates no residual flow through the fistula.
Figure 3
Figure 3
3-Dimensional Reconstruction of the Fistula, Before and After Occlusion (A) Preprocedural reconstruction image illustrating a large fistula between the proximal third of the right coronary artery and the superior vena cava. (B) Postprocedural reconstruction image illustrating a thrombosed fistula, featuring vascular occlusion devices at both the arterial (yellow arrow = RCA) and the venous (red arrow = SVC) termini.
See this image and copyright information in PMC

References

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