Work

Blind Fistulous Pouch After Coronary Artery Fistula Repair

Year: 2025

Type: article

Abstract: BACKGROUND: Coronary artery fistulas (CAFs) are rare, anomalous connections between a coronary artery and cardiac chamber or great vessel. Closure is often indicated to treat significant shunts or prevent complications, typically via surgical ligation or transcatheter device occlusion. CASE SUMMARY: An adolescent with a history of a repaired CAF presented with an ischemic stroke. Her work-up revealed a residual fistulous pouch. Etiology was presumed cardioembolic from a thrombus within the pouch, and she underwent transcatheter coil embolization. DISCUSSION: Long-term complications after repair occur in approximately 15% of cases with thrombotic events being the most common and serious. This case highlights a stroke after CAF repair, with advanced imaging critical in diagnosis and management. TAKE-HOME MESSAGES: Long-term management of CAF is complex and ongoing. High-quality advanced imaging is paramount to diagnose and prevent complications such as thromboembolic events and coronary obstruction. Cardiac computed tomography angiography with a fistula protocol was instrumental in diagnosis, intervention planning, and postintervention follow-up.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.104406

Authors: Gabriel Bahrami, John Lozier, Martin Bocks, Arpit Agarwal

Institution: Rainbow Babies & Children's Hospital

Language: English

Topic: Coronary Artery Anomalies

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850