An unusual case of an accessory coronary artery to pulmonary artery fistula: successful closure with transcatheter coil embolization.

Coronary artery fistulae (CAF) are rare congenital anomalies. Surgical ligation is the standard treatment for symptomatic CAF, but is associated with higher morbidity. In a select group of patients, transcatheter coil embolization (TCE) is a reasonable alternative to standard surgical treatment. In this article, we present a unique (not previously reported) case of a tortuous accessory anomalous right coronary artery to pulmonary artery fistula with coronary steal phenomenon. TCE of highly tortuous fistulae can be technically difficult and are usually referred for surgery. In this case report we describe how utilization of adult coronary interventional wires and balloon catheters may help overcome some of the technical difficulties encountered with catheter-based closure of CAF.