Transcatheter closure of a giant and tortuous right coronary artery-to-right atrium fistula in a child: a case report

Coronary artery fistula (CAF) is a rare congenital coronary anomaly characterized by an abnormal communication between a coronary artery and a cardiac chamber or vascular structure. Large fistulas may produce significant left-to-right shunting and progressive cardiac volume overload. We report a successful transcatheter closure of a giant and tortuous right coronary artery (RCA) to right atrium (RA) fistula in a 4-year-2-month-old girl using an Amplatzer® Vascular Plug II (AVP II) device. Echocardiography demonstrated a markedly dilated RCA fistula draining into the RA, with mild dilatation of the right atrium and right ventricle. Cardiac catheterization confirmed a giant and tortuous fistulous tract with aneurysmal dilatation. During the first attempt, the unreleased device became unstable and displaced but was successfully recaptured. The fistula was subsequently closed using an arteriovenous loop technique, without lasting clinical sequelae. Final angiography demonstrated complete occlusion without residual shunt or coronary compromise. Follow-up echocardiography showed the device to be well positioned without residual flow. This case highlights the feasibility of transcatheter closure in selected pediatric patients with complex coronary artery fistula anatomy.