Successful coil embolization of a large coronary artery fistula in a patient with congestive heart failure

Although a minority of coronary artery fistulae are small in caliper and may be asymptomatic throughout life, most cases will require intervention by either transcatheter tech- mques or surgery because of evolving symptoms. We report a 70-year-old female patient who underwent suc¬cessful coil embolization of a coronary artery fistula that was associated with congestive heart failure. On presen- tatıon. she had dyspnea, palpitation, chest pain, function- al capacity of NYHA class III, a pansystolic murmur of grade 3/6 in the right parasternal region, and a continuous murmur of grade 2-3/6 in the second left intercostal space and at the base of the heart. Selective coronary angiogra- phy showed a large coronary artery fistula, originating from the proximal left anterior descending coronary artery and draining into the main pulmonary artery. Embolization was performed with placement of one coil in the distal part and two coils in the proximal part of the fistula. The con¬tinuous murmur disappeared after the procedure. She was asymptomatic with significantly improved functional capacity at the second-month follow-up.