Journal of JCIC

We report a 4-year-old boy with congenital coronary artery fistula (CAF) in whom the coronary artery was unexpectedly shrunk during transcatheter closure. The patient underwent transcatheter closure because of dilated bilateral CAFs. Selective coronary angiography showed that one CAF drained from the right coronary artery (RCA) into the right ventricle (RV) with the maximum diameter of 11.2 mm and the other CAF also drained from the left circumflex artery into the RV with the maximum diameter of 5.4 mm. A 5 Fr-guiding sheath was introduced retrograde from the RV to the RCA, however, could not pass through the narrow part of the orifice. Though we attempted to deploy a 12-mm Amplatzer Vascular Plug-II® (AVP), the device was not appropriately positioned and the RCA was unexpectedly shrunk after several attempts. Alternatively, we applied antegrade approach and could successfully close the CAF using a 12-mm AVPII.