Transcatheter closure of a coronary fistula with an Amplatzer vascular plug: should a retrograde approach be standard?

Coronary artery fistulae are rare disorders. Only 2 reports in the medical literature discuss the use of vascular plugs to occlude coronary fistulae, and the same device-the Amplatzer Vascular Plug-was deployed via different techniques to treat those patients. The safety, the feasibility, and the standard approach to deployment have yet to be established. Herein, we describe the case of a 15-year-old boy who presented with a continuous murmur at the left sternal border. The patient was diagnosed with a large coronary fistula that originated from the right coronary artery and emptied into the right atrium. He underwent transcatheter closure of the fistula. We placed a 14-mm Amplatzer Vascular Plug into the narrowest part of the fistula, which resulted in complete occlusion and an excellent outcome. Our retrograde approach is simple and obviates the need to establish arteriovenous loops or to insert additional devices, such as coils. In this report, we compare our results with those of the 2 previous reports. To our knowledge, this is only the 2nd report that describes the closure of a coronary fistula in an adolescent patient by use of an Amplatzer Vascular Plug.