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Percutaneous closure of a coronary fistula

Percutaneous closure of a coronary fistula. Pawel Buszman, MD Silesian Medical School Katowice, Poland. Clinical data:. Male,40 year old Angina, CCS class 3 Risk factors: BMI 32, arterial hypertension

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Percutaneous closure of a coronary fistula

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  1. Percutaneous closure of a coronary fistula Pawel Buszman, MD Silesian Medical School Katowice, Poland

  2. Clinical data: • Male,40 year old • Angina, CCS class 3 • Risk factors: BMI 32, arterial hypertension • Tredmil stress test: 6 min., 7 METs, limited by angina and ST changes in precordial leads • Chest X-Ray suggesting L to R shunt • On auscultation: systolic murmur over PA

  3. Clinical data • UKG:LVEDD/LVESD 52/38 mmLVEF 55%RV 33 mm • Normal LV and valves function, no IVS or IAS defect

  4. Coronary angiography LAD-PAfistula IMA LAD-PAfistula S1 LCA: RAO30/Caud15 LCA: left lateral view

  5. Should the fistula be treated? • Clinical symptoms • Myocardial ischaemia on stress test • Features of L-R shunt on chest X-Ray The answer is: YES

  6. Percutaneous closure of the coronary fistula Jomed coronary graft stent on balloon 4.0 mm LCA: RAO30/Caud15post stent-graft implantation

  7. 6 month follow-up • No angina • Tredmil stress test:85% of MHR, 10 METS, no ischemia on ECG, • A control angio: no restenosis

  8. Stented segment Stented segment 6 month coronary angiography LCA: RAO30/Caud15 6 month follow-up LCA: LL90

  9. Conclusions • Coronary fistula can be completely closed with a graft stent. • Beacause of the risk of in stent restenosis a control coronary angiography should be taken after 6 month.

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