Coronary Artery Fistula Ligation Using Selective Coronary Artery Angiography

A 55-year-old male presented with worsening shortness of breath and was found to have multiple coronary artery fistulas on coronary angiogram with coronary steal. He subsequently underwent successful ligation of three of the fistulas using intraoperative coronary angiography in the hybrid suite to assist with the identification and confirmation of closure. There are currently no formal recommendations for the use of intraoperative imaging in such cases, but the results of our case contribute to the sparse body of literature supporting the utilization of intraoperative angiography in ligating multiple coronary artery fistulas.