Acute Myocardial Ischaemia following Transcatheter Occlusion of Coronary Artery Fistula in an Infant: A Case Report
Congenital coronary artery fistula is a rare anomaly defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure. Transcatheter closure of the fistula has been advocated as an effective alternative to surgical repair. It has been associated with uncommon complications, such as transient ischaemic electrocardiographic changes, arrhythmias, device embolization, myocardial infarction, and rarely death.
We described here a case of congenital right coronary artery – right ventricle fistula which was diagnosed postnatally. The patient developed overt heart failure soon after birth which was difficult to manage medically. He underwent successful transcatheter occlusion of the fistula with vascular plug at the age of 50 days old and was put on aspirin soon after the procedure. He developed symptoms of myocardial ischaemia nine days after the procedure with electrocardiography changes, raised cardiac enzyme, and well organised thrombus in the right coronary artery with poor myocardial contractility on echocardiogram. He responded to antithrombolytic therapy with ECG resolution followed by resolution of the thrombus. At follow up, he remained well with normal ECG and good myocardial contractility.
Congenital coronary artery fistula is a rare anomaly which can be successfully managed with transcatheter intervention. However, the patient needs to be closely followed up for possible complications post procedure.