Percutaneous closure of a large coronary fistula.

A16-year-old patient, female, diagnosed wwith a coronary artery fistula, was followed in the outpatient clinic since the first year of life. After referral for a murmur, the initial clinical and echocardiographic evaluation was of a right coronary artery fistula. At two years of age, cardiac catheterization showed a small fistula arising from the right coronary artery, near the origin of the sinus node artery, ending in the right atrium, not causing a significant shunt or dilation of the normal right coronary artery. A conservative approach was therefore adopted. At seven years of age, myocardial perfusion scintigraphy was normal. The patient remained asymptomatic until 16 years of age, when she experienced two syncopal episodes in the context of physical exertion. A non-invasive anatomical study was therefore performed with a 64-slice CT scan with threedimensional reconstruction, which showed a fistula originating immediately after the take-off of the right coronary artery, taking a posterior, inferior and rightward course, and ending with a partially thrombosed saccular dilation in the right atrium. The right coronary artery distal to the fistula was normal (Fig. 1A and B).