Transcatheter Occlusion of a Giant Coronary Artery Fistula in a Neonate

Patient: Female, newborn Final Diagnosis: Coronary arterial fistula Symptoms: Respiratory distress Medication: — Clinical Procedure: — Specialty: Cardiology • Pediatrics and Neonatology OBJECTIVE: Congenital defects/diseases BACKGROUND: Although large coronary artery fistulas are uncommon; they lead to substantial over-circulation in the pulmonary vascular beds and left heart system. Fistula occlusions are achieved via surgical or transcatheter technique; however, reports on successful outcomes of transcatheter treatment during the neonatal period are limited. CASE REPORT: A female infant was born at the gestational age of 37 weeks with a birth weight of 2615 grams via normal vaginal delivery. Cardiac auscultation revealed a loud continuous murmur emanating from the fourth right intercostal space. A right coronary artery-to-right ventricle fistula was confirmed using transthoracic echocardiography. The newborn developed respiratory distress 3 days after birth and was administered continuous positive airway pressure to assist breathing. On day 8, the ventilator was used through tracheal intubation due to gradual worsening of dyspnea. A 6-mm Amplatzer Vascular Plug 4 (AGA Medical Corporation, Plymouth, MN) was chosen, as the minimum diameter of the coronary artery fistula was 5 mm. In view of the risk of myocar-dial ischemia with additional devices, the procedure was stopped despite persistent shunting. The newborn’s clinical condition significantly improved following the procedure and she was eventually weaned off ventilator support. CONCLUSIONS: A self-expanding occlusion device was useful for relieving this life-threatening condition. Complete elimination of shunting is not always necessary, to avoid compromising myocardial circulation.