Antegrade approach for closure of distal and torturous congenital coronary artery fistula: A case report

RATIONALE: Coronary artery fistulae (CAF) are uncommon heart lesions, but they are the most frequent significant hemodynamic congenital coronary anomaly. Transcatheter closure is an alternative treatment and a variety of techniques and devices were reported to use for the closure of congenital coronary fistulae. PATIENT CONCERNS: We reported a 5-year-10-month-old boy who was diagnosed as CAF at birth. Follow-up transthoracic echocardiography showed persistent CAF and progressed dilatation of the left coronary artery. DIAGNOSES: Coronary angiography showed torturous coronary vessel and CAF at the distal segment of the left circumflex artery (LCX). INTERVENTION: Antegrade approach with Amplatzer Vascular Plug was used due to the retrograde approach failed and showed a good result. OUTCOMES: During a 3-year follow-up period, the patient showed no symptoms and demonstrated good exercise ability. Follow-up coronary angiography showed the Amplatzer vascular plug was located at an adequate position without a residual shunt from the CAF, and the diameter of the left coronary artery regressed when compared to previous angiography results. LESSONS: The antegrade approach is a feasible method for closing CAF if torturous vessels are noted and fistulae occur at the distal portion of the coronary artery. A large randomized study or case series are needed to investigate the comparison of antegrade and retrograde method for the closure of CAF.