Percutaneous closure of a coronary fistula

1
Percutaneous closure of a coronary fistula

• Pawel Buszman, MD
• Silesian Medical School
• Katowice, Poland

2
Clinical data

• Male,40 year old
• Angina, CCS class 3
• Risk factors BMI 32, arterial hypertension
• Tredmil stress test 6 min., 7 METs, limited by
  angina and ST changes in precordial leads
• Chest X-Ray suggesting L to R shunt
• On auscultation systolic murmur over PA

3
Clinical data

• UKGLVEDD/LVESD 52/38 mmLVEF 55RV 33
  mm
• Normal LV and valves function, no IVS or IAS
  defect

4
Coronary angiography
LAD-PAfistula
LAD-PAfistula
S1
IMA
LCA RAO30/Caud15
LCA left lateral view
5
Should the fistula be treated?

• Clinical symptoms
• Myocardial ischaemia on stress test
• Features of L-R shunt on chest X-Ray

The answer is YES
6
Percutaneous closure of the coronary fistula
Jomed coronary graft stent on balloon 4.0 mm
LCA RAO30/Caud15post stent-graft implantation
7
6 month follow-up

• No angina
• Tredmil stress test85 of MHR, 10 METS, no
  ischemia on ECG,
• A control angio no restenosis

8
6 month coronary angiography
LCA RAO30/Caud15 6 month follow-up
LCA LL90
9
Conclusions

• Coronary fistula can be completely closed with a
  graft stent.
• Beacause of the risk of in stent restenosis a
  control coronary angiography should be taken
  after 6 month.