PMC3915942_01
Computed tomography. Huge left circumflex artery to right atrium fistula (posterior view)
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F0001
In angio-CT left circumflex artery with possible multiple orifices to the right atrium was confirmed (Figure 1).
The same image as in Figure 1 in aortography (PA view)
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F0002
Aortography confirmed the presence of a huge CAF to the right atrium (Figure 2).
Crossing the fistula to right atrium with Pigtail catheter
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F0003
Terumo hydrophilic guide wire 0.35 cm x 260 cm was inserted into the dilated circumflex artery and later to the right atrium through the 6 mm orifice (Figure 3). The wire was snared using a lasso catheter in the superior vena cava (Figure 4) and exteriorized in the right femoral vein for the creation of an arteriovenous wire loop.
Arteriovenous loop creation
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F0004
Terumo hydrophilic guide wire 0.35 cm x 260 cm was inserted into the dilated circumflex artery and later to the right atrium through the 6 mm orifice (Figure 3). The wire was snared using a lasso catheter in the superior vena cava (Figure 4) and exteriorized in the right femoral vein for the creation of an arteriovenous wire loop.
Closure of the fistula with first 10/12mm Cardio- O-Fix PDA Occluder. Angiography in fistula lumen shows additional leak to right atrium is present
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F0005
With the 8 F delivery system the 12/10 Cardio-O-Fix (COF) PDA occluder (Starway Comp, China, Beijing) was opened (Figure 5), closing one orifice of the CAF.
Delivery sheath crossing another orifice of the fistula. First PDA occluder already detached in the position
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F0006
CAF - 3.5 mm diameter) was closed using a similar technique by a 10/8 mm PDA COF device (Figure 6-9). Complete closure of the coronary artery fistula and disappearance of the heart murmur were observed.
Deployment of the second 10/8 mm PDA Cardio- O-Fix occluder (device still attached to delivery system)
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F0007
CAF - 3.5 mm diameter) was closed using a similar technique by a 10/8 mm PDA COF device (Figure 6-9). Complete closure of the coronary artery fistula and disappearance of the heart murmur were observed.
Angiography in the fistula showing almost complete occlusion
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F0008
CAF - 3.5 mm diameter) was closed using a similar technique by a 10/8 mm PDA COF device (Figure 6-9). Complete closure of the coronary artery fistula and disappearance of the heart murmur were observed.
Final fluoroscopy. Note presence of 2 PDA occluders closing fistula (persistent contrast presence in the lumen of closed fistula), as well as third one closing PDA
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F0009
CAF - 3.5 mm diameter) was closed using a similar technique by a 10/8 mm PDA COF device (Figure 6-9). Complete closure of the coronary artery fistula and disappearance of the heart murmur were observed.