Tortuous Coronary Artery Fistula Closed Using a Microvascular Plug in Heart Failure.

Authors

Jasmin Kaur Bhullar, Christopher Walters

Published in

JACC. Case reports. Pages 110613. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

Large coronary artery fistulas may result in ischemia and heart failure.
A 74-year-old woman was found to have an ejection fraction of 20%-25% with apical and anterior akinesis. A large fistula from the left anterior descending artery to the pulmonary artery was identified as the likely etiology. Multiple attempts at closure failed in the setting of extreme tortuosity with nearly 180° bends. Eventually, a 5-mm vascular plug was advanced through a microcatheter and successfully deployed. Follow-up echocardiography demonstrated improvement of the ejection fraction to 40%-45% and complete resolution of the previous wall motion abnormalities.
This case illustrates a reversible coronary steal-mediated cardiomyopathy. It highlights the clinical utility of microcatheter-compatible vascular plugs for transcatheter closure of anatomically complex coronary fistulas, even in elderly patients.
Percutaneous closure of coronary artery fistulas with microcatheter-compatible devices improves cardiac function even in elderly patients.

PMID:
42893443
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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