Post-Endomyocardial Biopsy Fistula Between Left Anterior Descending Artery and Right Ventricle

J INVASIVE CARDIOL 2022;34(3):E251-E252.

Key words: coronary fistula, endomyocardial biopsy

A 69-year-old male patient underwent coronary angiography for evaluation of cardiac ischemia. He had a history of chronic heart failure due to Chagas disease and underwent a heart transplant in 2018. During follow-up, he remained asymptomatic and was regularly subjected to right ventricle endomyocardial biopsies (Figure 1) with no history of graft rejection.

At his last out-of-hospital evaluation, he underwent a 2-year control myocardial perfusion imaging to search for graft vascular disease, which demonstrated minor stress-induced apical ischemia (Figure 2). Despite the finding, the patient did not complain of chest pain or dyspnea.

Coronary angiography was performed and displayed a fistula between the left anterior descending artery and right ventricle with subsequent coronary occlusion (Figure 3 and Video 1). This is a rare, albeit reported, complication of endomyocardial biopsy.

The case was discussed within the heart team. Fistula occlusion with microcoils was considered; however, the patient was asymptomatic and presented no reduction of left ventricular ejection fraction, and the documented ischemia was minor. Therefore, the patient received conservative treatment.

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