Transcript Percutaneous closure of a coronary fistula

Percutaneous closure of
a coronary fistula
Pawel Buszman, MD
Silesian Medical School
Katowice, Poland
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

Clinical data

UKG:
LVEDD/LVESD
LVEF
RV

52/38 mm
55%
33 mm
Normal LV and valves function, no IVS or
IAS defect
Coronary angiography
LAD-PA
fistula
IMA
LAD-PA
fistula
LCA: RAO30/Caud15
S1
LCA: left lateral view
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
Percutaneous closure
of the coronary fistula
Jomed coronary graft stent
on balloon 4.0 mm
LCA: RAO30/Caud15
post stent-graft implantation
6 month follow-up
No angina
 Tredmil stress test:
85% of MHR, 10 METS, no ischemia on
ECG,
 A control angio: no restenosis

6 month coronary angiography
Stented segment
LCA: RAO30/Caud15
6 month follow-up
Stented segment
LCA: LL90
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.
