1. Percutaneous closure of a coronary fistula Pawel Buszman, MD Silesian Medical School Katowice, Poland

2. Clinical data: Male,40 year old Male,40 year old Angina, CCS class 3 Angina, CCS class 3 Risk factors: BMI 32, arterial hypertension Risk factors: BMI 32, arterial hypertension Tredmil stress test: 6 min., 7 METs, limited by angina and ST changes in precordial leads Tredmil stress test: 6 min., 7 METs, limited by angina and ST changes in precordial leads Chest X-Ray suggesting L to R shunt Chest X-Ray suggesting L to R shunt On auscultation: systolic murmur over PA On auscultation: systolic murmur over PA

3. Clinical data UKG: LVEDD/LVESD52/38 mm LVEF55% RV33 mm UKG: LVEDD/LVESD52/38 mm LVEF55% RV33 mm Normal LV and valves function, no IVS or IAS defect Normal LV and valves function, no IVS or IAS defect

4. Coronary angiography LAD-PA fistula S1IMA LCA: RAO30/Caud15LCA: left lateral view

5. Should the fistula be treated? Clinical symptoms Clinical symptoms Myocardial ischaemia on stress test Myocardial ischaemia on stress test Features of L-R shunt on chest X-Ray Features of L-R shunt on chest X-Ray The answer is: YES

6. Percutaneous closure of the coronary fistula Jomed coronary graft stent on balloon 4.0 mm LCA: RAO30/Caud15 post stent-graft implantation

7. 6 month follow-up No angina No angina Tredmil stress test: 85% of MHR, 10 METS, no ischemia on ECG, Tredmil stress test: 85% of MHR, 10 METS, no ischemia on ECG, A control angio: no restenosis A control angio: no restenosis

8. 6 month coronary angiography LCA: RAO30/Caud15 6 month follow-up Stented segment LCA: LL90

9. Conclusions Coronary fistula can be completely closed with a graft stent. Coronary fistula can be completely closed with a graft stent. Beacause of the risk of in stent restenosis a control coronary angiography should be taken after 6 month. Beacause of the risk of in stent restenosis a control coronary angiography should be taken after 6 month.