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Percutaneous Closure using a Vascular Plug for Treatment of Abnormal Nonfunctional Right Coronary Artery with Aneurysm and Coronary Arterio-Venous Fistula

- Operator: Anil Dhall, MD
Patient presentation

A 26 year old woman was admitted with exertional dyspnea. Her coronary angiogram showed aneurysmal dilatation of the right coronary artery (RCA) with huge coronary arterio-venous (AV) fistula, drained to the right ventricle (Image 1, Image 2). Calculated Qp/Qs was 1.7. Because the RCA did not perfuse to the myocardium, occlusion of the abnormal RCA was planned to treat both the aneurysm and the fistula with a percutaneous device. Left coronary system was intact with supplying the whole myocardium.

Procedure

Right coronary ostium was engaged with 7Fr AL2 guiding catheter (Image 3). A self expandable vascular occluding plug was inserted into the proximal portion of RCA (Image 4). After appropriate positioning, the vascular plug was deployed. Final angiogram showed markedly diminished blood flow through the coronary AV fistula (Image 5).

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