PMC9971947_01
The anatomy of CAF. (A,B) The tortuous aneurysmal CAF originated from main coronary artery (MCA), made a 180  turn underneath the LAD and MCA, and coursed backward to drain into the LA. (C) The drainage opening measuring 4.5 mm, was located at the LA roof between the aortic root and LAA. (D) The thoracic computed-tomographic-angiography to determine the access. CAF, coronary artery fistula; AO, ascending aorta; LAD, left anterior descending branch; LA, left atrium; LAA, left atrial appendage.
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F1
TEE showed the CAF originated from main coronary artery (MCA) and drained into the LA with a continuous left-to-left shunt. The maximum inner diameter of the CAF was 11 mm and the left ventricular end diastolic diameter was 59 mm. The CTA was performed to delineate the anatomy of the CAF (Figures 1A-C). A bone-reserved thoracic CTA was also performed before the procedure to determine the exact location of the incision and procedure planning (Figure 1D). These records demonstrated an appropriate device position and complete occlusion of the CAF and no complications (Figures 3A-D). The Supplementary Figure 1 shows the device and stay-in-suture use.
Schematic presentation of percoronary device closure of CAF. (A) The subaxillary incision. (B) The distal straight section of CAF was exposed between the main pulmonary artery (MPA), root of AO, and the LAA. A purse-string suture was placed on it. (C) Following a puncture in purse-string, a flexible guidewire was advanced into LA. Then, a 6F short delivery sheath was fed over the wire into the LA. (D) The device was deployed and positioned at the drainage orifice of the CAF. CAF, coronary artery fistula; AO, ascending aorta; LAA, left atrial appendage; LA, left atrium; MPA, main pulmonary artery; MCA, main coronary artery.
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F2
Figure 2 showed the steps of percoronary device closure of CAF.
Pre- and post-procedural comparison of CAF. (A-D) The CAF disappeared and thrombogenesis occurred from distal to proximal segment of the CAF. CAF, coronary artery fistula; AO, ascending aorta; LAD, left anterior descending branch; LA, left atrium; arrow, fistulous drainage orifice.
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F3
These records demonstrated an appropriate device position and complete occlusion of the CAF and no complications (Figures 3A-D). The Supplementary Figure 1 shows the device and stay-in-suture use.