Coronary fistula embolization with neurovascular microcoils

This is the case of a 55-pound 6-year-old male diagnosed with right coronary artery (RCA) fistula draining into the right ventricle (RV). Due to progressive dilatation of the RCA, percutaneous closure was decided. The femoral artery and veins were canalized using 5-Fr and 6-Fr introducer sheaths, respectively. A right coronary angiography revealed the presence of a RCA proximal to the 7.1 mm fistula—a fistula with a 11.2 mm × 7.2 mm bilobulated aneurysm with a 2.1 mm right ventricular outflow tract—and a coronary artery distal to the fistula of normal diameter (figure 1, figure 2, and video 1 of the supplementary data). Figure 1. Figure 2. The fistula was catheterized with a coronary guidewire that was advanced towards the pulmonary artery where it was captured with a snare creating an arteriouvenous loop. From the venous side of this loop a 4 mm × 8 mm Apex Monorail balloon catheter (Boston Scientific, United States) was advanced and then inflated in the ostium of the fistula in the RV for 10 minutes without any signs of ischemia. Considering the risk of progressive aneurysmal dilatation if the fistula was closed in its distal edge and given the lack of space to fit a device in its proximal edge,...