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(Circulation. 2006;114:e631-e634.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Coronary Artery Fistula With a Huge Aneurysm Treated by Transcatheter Coil Embolization

Sang-Ho Jo, MD; Young-Jin Choi, MD, PhD; Dong-Jin Oh, MD, PhD; Chong-Yun Rhim, MD, PhD

From the Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea.

Correspondence to Young-Jin Choi MD, PhD, Associate Professor, Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431–070, South Korea. E-mail cyj{at}hallym.or.kr

A 75-year-old man presented with chest pain that suggested angina. His only risk factor for coronary artery disease was smoking. He had not experienced chest trauma or thoracic surgery. Cardiac echocardiography revealed severe hypokinesia at the myocardial territory of left anterior descending coronary artery (LAD), and myocardial perfusion scan showed reversible ischemia at the same region. Coronary angiography revealed a fistula at the LAD and a huge aneurysm connected to it (Figure 1A, arrow). Blood was spouting out to the aneurysmal sac (Figure 1A, arrowhead), and the LAD had a narrow portion just distal to the ostium of the feeding artery. Coronary computed tomography angiography (Figure 1C) and 3-dimensional reconstruction imaging revealed that the aneurysmal sac was compressing the mid-LAD (Figure 2, arrow). We dilated the mid-LAD narrowing with percutaneous transcatheter coronary artery ballooning and stenting, and then we embolized the feeding artery to the aneurysm by transcatheter coiling. (Figure 3A). Intravascular ultrasound showed that the extrinsic compression by the aneurysmal sac (Figure 1B) was relieved after coronary stenting and fistula coiling (Figure 3B). Follow-up coronary computed tomography angiography showed a regressed aneurysmal sac and nonvisible dye filling in the sac (Figure 3C). Six months after the procedures, the patient reported no symptoms and was doing well.

View larger version (59K): [in this window] [in a new window]   Figure 1. A, Coronary angiogram shows fistula of the left anterior descending coronary artery (LAD) connected to a huge aneurysm (arrows) and blood spouting out to the aneurysmal sac (arrowhead). B, Intravascular ultrasound image of the LAD shows an aneurysm compressing LAD. C, Computed tomography angiogram shows huge aneurysm (bidirectional arrow).

View larger version (74K): [in this window] [in a new window]   Figure 2. Three-dimensional computed tomography shows huge aneurysm compressing the proximal LAD.

View larger version (61K): [in this window] [in a new window]   Figure 3. A, Coronary angiogram shows that the fistula is occluded without visualization of huge aneurysmal sac (arrow) after transcatheter coil embolization of fistula. B, Intravascular ultrasound shows relieved compression of LAD after coronary stenting. C, Follow-up computed tomography angiogram shows regressed aneurysmal sac with no dye filling after fistula coiling (bidirectional arrow).

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data Supplement, consisting of movie files, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/24/e631/DC1.

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Issue Highlights
Circulation 2006 114: 2571. [Full Text]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jo, S.-H. Articles by Rhim, C.-Y. Search for Related Content PubMed PubMed Citation Articles by Jo, S.-H. Articles by Rhim, C.-Y. Related Collections Catheter-based coronary and valvular interventions: other Coronary imaging: angiography/ultrasound/Doppler/CC Related Article