Percutaneous, catheter-based coil embolization of coronary fistula: determination of hemodynamic relevance.
A 55-year-old male with angina-like chest pain and positive thallium-scintigraphy was admitted to our hospital. Cardiac catheterization was performed for suspected coronary artery disease. The coronary angiogram showed no significant epicardial stenosis, but a large coronary fistula, connecting the left anterior descending artery with the pulmonary artery. Swan-Ganz catheter measurements, intracoronary Doppler, and quantitative coronary angiography were used to determine cardiac output, coronary blood flow, and coronary-to-pulmonary artery shunt fraction. These measurements showed a hyperdynamic cardiac output of 17 L/min, a coronary blood flow of 140 mL/min in the left anterior descending coronary artery with an estimated shunt fraction of 58% into the pulmonary circulation. Percutaneous, catheter-based coil embolization was performed to occlude the fistula. After embolization of one coil, coronary angiography showed the fistula's stump only. Cardiac output (9 L/min) and coronary blood flow (48 mL/min) were almost normalized. The patient was discharged from the hospital the day after the procedure. After a 6-month follow-up, there were still no complaints, angina-like symptoms or signs of myocardial ischemia in stress tests.
Oldenburg
Olaf
O
Department of Cardiology, Division of Internal Medicine, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany. olaf.oldenburg@uni-essen.de
Philipp
Thomas
T
Forsting
Michael
M
Erbel
Raimund
R
D002302:Cardiac Output; D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005402:Fistula / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged