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Circulation. 2001;104:e19
doi: 10.1161/hc3001.093607
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(Circulation. 2001;104:e19.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Transcatheter Therapeutic Embolization of Multiple Coronary Artery Fistulas

Jiri Vitek, MD, PhD; Jeffrey W. Moses, MD; Gary S. Roubin, MD, PhD; Martin B. Leon, MD; Nicholas Kipshidze, MD, PhD

From Lenox Hill Heart and Vascular Institute of New York and Cardiovascular Research Foundation, New York City, NY.

Correspondence to Nicholas Kipshidze, MD, PhD, Lenox Hill Heart and Vascular Institute, 130 East 77th Street, Black Hall, 9th Floor, New York, NY 10021. E-mail nkipshidze{at}lenoxhill.net

Coronary artery fistulas, although rare, are the most prevalent and hemodynamically significant congenital malformation of the coronary circulation. Diffuse, multiple fistulas involving both the left and right coronary arteries are even rarer. This disorder has traditionally been managed by surgical ligation. However, now that closure by a transcatheter technique has been successful, endovascular therapy with different methods (including embolic coil devices, Rashkind double umbrella device, Amplatzer duct occluder, detachable balloons, and covered stents) has recently been used with encouraging results.

A 61-year-old man presented with exertional angina and myocardial ischemia, as evidenced by a positive stress exercise teSt. Percutaneous transcatheter retrograde embolization of multiple fistulas was performed using twenty-one 0.18-inch fibered Platinum coils (9 coils at 6x6 mm, 7 coils at 4x7 mm, and 5 coils at 2x5 mm). The Figure shows his coronary angiogram.



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  		Coronary angiography showing multiple coronary fistulas from the branches of the right coronary artery. A, Fistula from ventricular branch of right coronary artery that was 3 mm in diameter (arrows). B, Control angiography reveals occlusion (arrow) of the fistula. C, Selective angiography showing multiple fistulas (arrows) from atrioventricular nodal branch of right coronary artery, which was 5 to 6 mm in diameter. D, Visualization of right coronary artery (bottom arrow) after procedure; upper arrows indicate closure of multiple fistulas. E, Coil embolization of fistula (arrows) from septal branch of left anterior descending artery; this fistula was 6 mm in diameter. F, Patent left anterior descending artery (arrows) and no flow in fistula.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology. St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Ofiice, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.




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Right arrow Cardiac development
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Right arrow Catheter-based coronary and valvular interventions: other
Right arrow Coronary imaging: angiography/ultrasound/Doppler/CC

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