PMC8823088_01
Right Coronary Artery (RCA) with the right part of the fistula (A), Left Coronary Artery (LCA) with the left part of the fistula (B), Selective LAD injection (C). Baseline CCT with 2D Maximum intensity projection of the fistula (D) and 3D volume rendering of the heart (E). TOE before fistula closure (F). LAD, left anterior descending artery; CCT, cardiac CT; TOE, transoesophageal echocardiogram.
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F1
Coronary angiography revealed two fistulas arising from the right and left coronary arteries, both terminating in the pulmonary artery (PA) without significant stenosis visualized (Figures 1A,B; Supplementary Videos 1, 3). The left anterior descending artery (LAD) was injected selectively as it was poorly visualized behind the fistula (Figure 1C, Supplementary Video 2). A cardiac CT (CCT) scanner was performed, confirming a common merging of the two fistulas (6 mm of diameter) before entering the anterolateral left part of the trunk of the PA (Figures 1D,E). TOE was performed (Figures 1E,F, Supplementary Video 6). The fistula was again cannulated by retrograde approach with the same SIM 1 diagnostic catheter.
Right Coronary Artery (RCA) angiogram (A), Left Coronary Artery (LCA) angiogram (B), TOE (C), chest radiography (D) after fistula closure. CCT after the intervention with 2D Maximum intensity projection of the fistula (E) and 3D volume rendering of the heart (F). TOE, transesophageal echocardiogram; CCT, cardiac CT.
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F2
The left anterior descending artery (LAD) was injected selectively as it was poorly visualized behind the fistula (Figure 1C, Supplementary Video 2). In the proximal part of the fistula, a plug AVP IV 13.5/8 mm (Abbott, USA) was implanted with a nearly complete closure of the fistula (Figures 2A-C; Supplementary Video 2, Supplementary Videos 8, 9). Thorax radiography confirmed the position of the plug close to the coils (Figure 2D). The patient was discharged on day 3. A control CCT confirmed the fistula's closure (Figures 2E,F).