Coronary Cameral Fistula

A 23-year-old male presented to the hospital with non-radiating pain and palpitations. An echocardiogram showed a dilated left coronary artery and coronary sinus. Computed tomographic (CT) angiography showed markedly dilated left main and left circumflex arteries. The left circumflex artery opened directly into the coronary sinus, consistent with a coronary arterio-venous fistula (Figure 1). Coronary arteriography confirmed the above findings (Figure 2). Because the angiograms obtained from cannulating the left main coronary artery opacified the fistula poorly due to significant runoff, diagnostic angiograms were performed by selectively cannulating the fistulous tract. A headhunter catheter was tracked over the guidewire from the right jugular vein via the right atrium, coronary sinus, fistulous tract, left circumflex artery and left main artery into the ascending aorta. After passing the delivery sheath over the noodle wire, an Amplatzer duct occluder was slenderized and pushed until the aortic retention disc protruded out of the sheath. Post-deployment angiography revealed slow flow within the fistula (Figure 3), with a mild residual shunt through the device (Figure 4).

________________________________________ From Parkway Cardiology Associates, Oak Ridge, Tennessee The authors report no conflicts of interest regarding the content herein. Manuscript submitted December 1, 2009 and accepted December 7, 2009. Address for correspondence:. Amyn Malik, MD, Parkway Cardiology Associates, 80 Vermont Avenue, Oak Ridge, TN 37830. E-mail: amynmalik2001@yahoo.com