<p><strong>Transcatheter closure of a coronary artery fistula between the left circumflex artery and the coronary sinus. A case report.</strong></p>

<p>Introduction: Coronary artery fistula (CAF) is a very rare congenital heart disease occurring in less than 0,2 % of all cardiac congenital anomalies. The fistulous connection between the left circumflex artery and the coronary sinus is reported in case series. Several therapeutic modalities are possible, surgical or percutaneous closure and even abstention in the asymptomatic form. The optimal strategy is not established yet due to the scarcity of data.</p>

<p>Case report: A 15-year-old patient was referred to our institution to explore a continuous heart murmur. The patient was asymptomatic. Electrocardiography showed normal sinus rhythm and no specific changes in the ST segment and T wave. Coronary angiography revealed a fistulous connection between the circumflex artery and the coronary sinus, which both of them were markedly dilated. We proceeded to an anterograde percutaneous closure of the fistula with an AMPLATZER duct occluder II 6 x 4 mm. the post-operative course was uneventful.</p>

<p>Discussion: CAF management is not clearly defined and most reports recommend a conservative treatment in asymptomatic forms. In our case, we decided to close the fistula because of its large size described as an independent predictor of mortality in some studies. Taking into consideration the localization and complexity of the fistula anatomy, the choice of the patient and the absence of other congenital anomalies, the transcatheter approach seemed to be an attractive alternative treatment option.</p>

<p>Conclusion: CAF remains an underestimated entity due to the high incidence of the asymptomatic form but it&rsquo;s a life threatening disease. It should be considered as a specific etiology of myocardial ischemia by a steal phenomenon, tamponnade by the rupture of the dilated vessel and even endocarditis. Several techniques have been proposed to eliminate this defect. Herein, we report a successful deployment of an AMPLATZER duct occluder as a simple and safe technique.</p>

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