Transcatheter Closure of Coronary Artery Fistula with Giant Aneurysm by Arteriovenous Loop Approach: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Right coronary artery-right atrial fistula with a giant aneurysm (n=1). Intervention: Transcatheter interventional closure (using an arteriovenous loop approach). Primary outcome: Symptom resolution and maintenance of sinus rhythm.

Haojie Zhang; Caiqing Deng; Xintian Liu; Feng Li; Menghuan Yan; Xuan Zheng; Gangcheng Zhang

doi:10.32604/schd.2026.079571

January 1, 2026Structural and Congenital Heart DiseaseOpen Access

Transcatheter Closure of Coronary Artery Fistula with Giant Aneurysm by Arteriovenous Loop Approach: A Case Report

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Key result

Transcatheter closure of RCA-RA fistula with giant aneurysm eliminates palpitations and maintains sinus rhythm through 2 years.

n=1

Why the study?

Adult congenital coronary artery fistulas are rare with diverse clinical manifestations and complex anatomy, and cases presenting primarily with arrhythmia are exceptionally rare.

Key Points

To describe the multimodal imaging diagnosis and successful transcatheter interventional repair of an adult congenital coronary artery fistula complicated by a giant aneurysm.
Evaluated a 57-year-old male presenting with intermittent palpitations via electrocardiography, transthoracic echocardiography (TTE), and cardiac computed tomography angiography (CTA).
Established an arteriovenous loop track and delivered a 10 mm occluder using a 9F/180° delivery system via the femoral vein under X-ray fluoroscopic guidance.
Diagnostic imaging identified a right coronary artery-to-right atrial fistula with a giant aneurysm measuring 5.7 cm × 5.0 cm on TTE (5.8 cm × 6.0 cm on CTA) and an internal defect diameter of 0.8 cm (narrowest fistula orifice: 5.8 mm).
Catheter-based occlusion was completed with minimal residual shunt at the occluder edge and no obstruction of the right coronary artery.
The patient returned to normal sinus rhythm on postoperative day 4 and remained in sinus rhythm throughout the 2-year follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 57-year-old male presenting with intermittent palpitations diagnosed with a right coronary artery-right atrial fistula and a giant aneurysm, followed for 2 years.

I

Intervention

Percutaneous transcatheter closure of the coronary artery fistula using an arteriovenous loop approach with a 10 mm occluder (Huayi Shengjie V10 mm), followed by clopidogrel monotherapy for 1 year after initial anticoagulation/DAPT was discontinued due to vascular hematoma.

O

Outcome

Procedural success, symptom resolution, and aneurysm reduction at 2-year follow-up.

Limitations

As a single case report, findings may not be generalizable to all patients with coronary artery fistulas.
Long-term durability of percutaneous closure for giant coronary aneurysms remains unknown.
Potential for delayed complications such as device migration, thrombosis, or aneurysm rupture cannot be excluded.
The patient's pre-existing hypertension may have contributed to aneurysm progression, acting as a potential confounder.
The arteriovenous loop approach and specific occluder used may not be available or suitable in all centers.
Single case report, findings may not be generalizable to all patients with CAFs
Long-term durability of percutaneous closure for giant coronary aneurysms remains unknown
Potential for delayed complications such as device migration, thrombosis, or aneurysm rupture cannot be excluded
Patient's pre-existing hypertension may have contributed to aneurysm progression (confounder)
Arteriovenous loop approach and specific occluder used may not be available in all centers

Implication

Transcatheter closure using an arteriovenous loop approach is a feasible and effective treatment for adults with symptomatic complex congenital coronary artery fistulas complicated by giant aneurysms.

Abstract

Background: Adult congenital coronary artery fistulas (CAFs) are rare cardiac structural abnormalities that present with diverse clinical manifestations and complex anatomical features. Cases primarily presenting with arrhythmia are exceptionally rare. Percutaneous intervention or surgical correction offers effective strategies for mitigating patients’ symptoms. Case Description: We report a 57-year-old male with CAFs who presented with palpitations as the initial symptom. Both transthoracic echocardiography (TTE) and cardiac computed tomography angiography (CTA) confirmed a right coronary artery-right atrial fistula complicated by a giant aneurysm. Following transcatheter interventional closure of the CAFs, the patient remained in sinus rhythm during the 2-year follow-up. Conclusion: This case report describes different clinical presentation types of giant coronary artery aneurysms and emphasizes the pivotal role of multimodal imaging in the diagnosis and treatment of CAFs.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a case report in Right coronary artery-right atrial fistula with a giant aneurysm (n=1). Transcatheter interventional closure (using an arteriovenous loop approach) was evaluated on Symptom resolution and maintenance of sinus rhythm. Transcatheter interventional closure of a right coronary artery-right atrial fistula complicated by a giant aneurysm successfully eliminated palpitations and maintained sinus rhythm over 2 years.

synapsesocial.com/papers/6ad0fcb515427f6a8404028e https://doi.org/10.32604/schd.2026.079571

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Transcatheter Closure of Coronary Artery Fistula with Giant Aneurysm by Arteriovenous Loop Approach: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Transcatheter Closure of Coronary Artery Fistula with Giant Aneurysm by Arteriovenous Loop Approach: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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