[Closure of coronary fistula with the Amplatzer duct occluder system].

We describe a case of a 54-year-old woman with a history of palpitations due to recurrent atrial fibrillation. The diagnosis of a coronary artery fistula between the right coronary artery and right atrium was made after the detection of a continuous cardiac murmur. In view of the patient symptoms and owing to the aneurysmatic dilation of the fistula, she was submitted to percutaneous closure. The anatomic features of the fistula and the closure device used demonstrate the peculiarity of the intervention. An artery-venous loop crossing the coronary fistula was created via the femoral vein and artery; the Amplatzer duct occluder was then advanced through this loop up to the fistula neck and successfully delivered. At 1-month follow-up the patient was totally asymptomatic. Cardiac auscultation revealed that the murmur was no longer detectable. Current guidelines for the treatment of coronary fistulas and on their percutaneous closure are discussed.