Transcatheter Coil Embolization of a Huge Right Coronary Artery to Right Ventricle Fistula

Coronary artery fistula is a rare congenital heart disease. Treatment including medical control or intervention is only indicated for symptomatic children. It has been reported that transcatheter coil embolization is appropriate for symptomatic patients with a single fistula, safe accessibility to the feeding coronary artery, and the absence of large branch vessels. In this case report, we present a 4-year-old boy who was found by cardiac catheterization to have a huge isolated right coronary artery-to-right ventricle fistula. The patient initially presented at one year of age with an asymptomatic continuous grade Ⅱ/Ⅵ murmur over the left-lower sternal border. Echocardiography demonstrated a continuous turbulent flow in the right ventricle and a dilated aneurysmal right coronary artery, suggesting the presence of a right coronary artery fistula. As the patient was asymptomatic, he was followed closely without definitive treatment. Over the next three years, he gradually developed mild exertional dyspnea and decreased exercise tolerance. Serial electrocardiograms revealed biventricular hypertrophy, and echocardiography revealed progressive right coronary arterial dilatation. Cardiac catheterization eventually confirmed the diagnosis, and the fistula was occluded by percutaneous transcatheter coil embolization. The boy remained well after the procedure with resolution of his symptoms. In conclusion, coil embolization is a safe alternative for the treatment of coronary artery fistula.