Bilateral Coronary Artery-Right Ventricular Fistula with Rare, Large Tortuosity and Common Exit

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Bilateral coronary artery-right ventricular fistula (n=1). Intervention: Percutaneous transcatheter vascular plug occlusion (AMPLATZER II and IV Vascular Plugs) followed by dual antiplatelet therapy. Primary outcome: Complete fistula occlusion and post-treatment vessel remodeling at 6 months.

Q: What does this research mean for the field?

Transcatheter arterial closure of complex bilateral coronary artery fistulas with a common right ventricular exit is clinically feasible, with occlusion placed near the fistula origin yielding more complete thrombosis and superior vascular remodeling than distal occlusion. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Tang Wei-song; Hairong Li

doi:10.21203/rs.3.rs-11104574/v1

November 6, 2026Open Access

Bilateral Coronary Artery-Right Ventricular Fistula with Rare, Large Tortuosity and Common Exit

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Key result

Percutaneous plug occlusion achieves complete closure of bilateral coronary-right ventricular fistulas and resolves dyspnea.

n=1

Why the study?

This study was conducted to enhance clinical awareness regarding the diagnosis and treatment of complex congenital bilateral coronary artery fistula involving the RCA, LAD, and RV.

Does percutaneous transcatheter vascular plug occlusion achieve complete closure and favorable anatomical remodeling in a patient with a complex bilateral coronary artery-right ventricular fistula with a common exit?

Key Points

To describe the angiographic features, interventional occlusion technique, and clinical outcomes of a rare bilateral coronary artery fistula entering the right ventricle through a common exit, accompanied by a 50-year systematic review.
A systematic search of PubMed was conducted for bilateral coronary artery fistula cases published between 1974 and 2020.
A patient presenting with dyspnea, bilateral fistulas from the right coronary artery and left anterior descending artery, and a Qp/Qs ratio of 2.01 underwent selective retrograde transcatheter arterial occlusion.
Vascular remodeling and thrombotic occlusion were evaluated using coronary computed tomography angiography at 6 months post-intervention.
The literature review of 32 bilateral cases identified pulmonary artery drainage in 28 cases (87%), origin from both the left anterior descending and right coronary arteries in 18 cases (56%), separate terminations in 26 cases (81%), and shared exits in 6 cases (18%).
Among the 32 reviewed cases, management consisted of conservative treatment in 17 patients (53%), surgical repair in 12 patients (37%), and interventional therapy in 3 patients (9%).
In the reported case, arterial catheter occlusion was completed; at 6 months, proximal right coronary artery fistula closure achieved complete thrombosis and optimal remodeling, whereas distal occlusion of the left anterior descending fistula left a residual proximal cul-de-sac.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does percutaneous transcatheter vascular plug occlusion achieve complete closure and favorable anatomical remodeling in a patient with a complex bilateral coronary artery-right ventricular fistula with a common exit?

P

Population

1 20-year-old male with complex congenital bilateral coronary artery-right ventricular fistula (Qp/Qs 2.01) presenting with exercise-induced dyspnea, followed for 6 months after percutaneous occlusion.

I

Intervention

Percutaneous interventional occlusion via right femoral artery access using one 7mm AMPLATZER II Vascular Plug at the distal end of the left coronary artery fistula (LCAF) and two 7mm AMPLATZER IV Vascular Plugs in the right coronary artery fistula (RCAF), followed by post-procedural dual antiplatelet therapy with oral aspirin 100 mg once daily and clopidogrel 75 mg once daily.

O

Outcome

Complete occlusion of the bilateral coronary artery fistula without residual shunt and subsequent anatomical remodeling on coronary computed tomography angiography (CCTA) at 6 months.surrogate

This case report and literature review demonstrate the feasibility of percutaneous vascular plug occlusion for rare, tortuous bilateral coronary artery-right ventricular fistulas with a common exit, highlighting that proximal closure resulted in more optimal vessel remodeling than distal closure at 6 months.

Limitations

Single-patient case report design with limited generalizability
Suboptimal remodeling of the left coronary artery fistula with partial thrombosis creating a residual cul-de-sac at 6 months
Lack of standardized postoperative antithrombotic medication guidelines for bilateral coronary artery fistulas
Long-term outcomes require confirmation through further extended follow-up
Long-term outcome needs to be confirmed by further follow-up.
There is no standardized postoperative medication regimen to refer to.

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Implication

Supports percutaneous closure feasibility in rare bilateral fistulas; leaves open prospective data on remodeling and durability.

Abstract

We present a case study of a complex congenital bilateral coronary artery fistula (CAF) involving the right coronary artery (RCA), left anterior descending artery (LAD), and right ventricle (RV). The angiographic features and imaging data during interventional occlusion are described, and a systematic review of published cases of this disease in the past 50 years is conducted to enhance clinical awareness regarding the diagnosis and treatment of this condition.

Discussion

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Cite This Study

Wei-song et al. (2026) conducted a case report in Bilateral coronary artery-right ventricular fistula (n=1). Percutaneous transcatheter vascular plug occlusion (AMPLATZER II and IV Vascular Plugs) followed by dual antiplatelet therapy was evaluated on Complete fistula occlusion and post-treatment vessel remodeling at 6 months. Percutaneous occlusion with three 7mm AMPLATZER vascular plugs achieved complete closure of a bilateral coronary artery-right ventricular fistula (Qp/Qs 2.01) with resolution of dyspnea at 6 months.

synapsesocial.com/papers/6aefbd5d50d2071ffda4bcbb https://doi.org/10.21203/rs.3.rs-11104574/v1

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Bilateral Coronary Artery-Right Ventricular Fistula with Rare, Large Tortuosity and Common Exit

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Bilateral Coronary Artery-Right Ventricular Fistula with Rare, Large Tortuosity and Common Exit

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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