Endovascular management of a coronary artery to pulmonary artery fistula with detachable balloons: a case report

Coronary arteriovenous (AV) fistulae are rare congenital anomalies and encompass a wide variety of communications between the coronary artery and the pulmonary or systemic vasculature. Symptoms depend on the presence and severity of myocardial malperfusion secondary to coronary artery steal phenomenon at rest or exertion. These fistulae are traditionally treated by open surgery. Endovascular therapy has been reported with the use of fibered coils. We report a case of a large left anterior descending (LAD) coronary artery to the main pulmonary artery fistula that was incidentally discovered during a pre-operative work up in a 28-year-old woman. The fistula was successfully treated with detachable balloons, however the patient developed delayed thrombosis of the coronary artery after 7 years of endovascular therapy requiring surgical bypass to the coronary artery.