Coronary-cameral fistula (CCF) is an uncommon congenital or acquired cardiac anomaly, which consists of an abnormal communication between a coronary artery and cardiac chamber. CCFs from the left circumflex coronary arteries are rare involved and drainage to the left ventricle (LV) is less common (less than 3%). We present a 32-year-old man who was admitted to our hospital with a history of fatigue, fever, and dyspnea on exertion. On the physical examination, there was a left parasternal murmur. Transthoracic echocardiography (TTE) showed vegetation on the mitral and aortic valve, and an abscess cavity was observed near the posterior mitral leaflet. With pulsed wave Doppler of the TEE image, the structure that was believed to be an abscess cavity was
revealed to be dilated coronary arteries. A multi-slice computed tomography showed dilated left main and left circumflex (LCx) arteries. CCF was also recognized between the circumflex artery and the LV on the tomographic images (Fig. 1a, b). After valve operation, coronary intervention was planned for coronary fistula (Fig. 2). With a guiding catheter, a stiff wire was passed from LCx, through the fistula, into LV and aorta (Fig. 3). Next, an 18×14 mm Amplatzer Vascular Plug II (St. Jude Medical, St. Paul, Minnesota) was deployed at the distal portion of LCx (Video 1). After delivery of the vascular plug, the angiography showed that there was no contrast medium flowing into LV through the fistula (Fig. 4, Video 2). Transcatheter closure was a safe and effective treatment method for CCF.
Figure 1.
a, b. The fistulization of ectatic circumflex coronary artery to the LV is shown on “volume rendered’’ (VR) three dimensional view (arrow) (a). CT angiography showing the distal part of the large CCF (FO-fistula orifice) entering the LV (b)
Figure 2.
Cardiac catheterization (left anterior oblique 44°, cranial 2°) revealing coronary artery fistula, connecting ectatic circumflex artery (LCx) to LV (black arrows)
Figure 3.
Cineangiogram image (left anterior oblique 44°, cranial 2°) showing a stiff wire
Figure 4.
Selective left coronary angiogram (right anterior oblique 8°, caudal 20°) following fistula closure with Amplatzer vascular plug (arrow)
LCx - left circumflex artery
Video 1
Amplatzer Vascular Plug II device released into distal portion of LCx
Video 2
After delivery of the vascular plug, there was no contrast medium flowing into LV through the fistula
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