SUCCESSFUL PERCUTANEOUS CLOSURE OF A COMPLEX CORONARY-TO-PULMONARY ARTERY FISTULA USING A DETACHABLE BALLOON - BENEFITS OF INTRA-PROCEDURAL PHYSIOLOGICAL AND ANGIOGRAPHIC ASSESSMENT

A 48-yr-old woman presented with a loud continuous precordial murmur and symptoms of fatigue. Color-flow doppler imaging and nuclear magnetic resonance imaging failed to show the cause of the murmur. Diagnostic catheterization showed a large left anterior descending coronary artery to pulmonary artery fistula with impaired left ventricular wall motion. Two detachable balloons were deployed in the fistula with complete abolition of flow in the main fistula channel. A small parallel channel of the fistula, previously not appreciated due to vessel overlap, remained patent but had trivial flow as assessed by green-dye and oximetric techniques. The patient had immediate resolution of her symptoms and return of normal ventricular wall motion.