[Sandwich stenting to treat an ostial left main narrowing following transcatheter aortic valve implantation].

2. ained into the right ventricle (Fig. 1A). The underdeveloped ht descending coronary artery presented another coronary tery fistula draining into the right ventricle (Fig. 1C). Both tula paths were occluded by deploying 10 coils via radial cess (Figs. 1B and D). Final results were good with no mplications. During her check-up after 8 weeks, the patient reported a ear improvement in functional class, having presented no rther symptoms of angina despite receiving no anti-angina ugs other than 100 mg losartan/day for high blood pressure ntrol for more than 6 years. She underwent control exercise sting, completing the Bruce protocol stage 3 and reaching 96% MHR with neither electrical nor clinical changes. During a cond stress echocardiograph test, she reached MHR in the aximum stage of 40 mg/kg/min without presenting electrical echocardiographic changes. A congenital coronary artery fistula is an abnormal commucation between an epicardial coronary artery and a cardiac amber or vascular structure located near the heart: 40% to the ht ventricle, 25% right atrium, 15% to 20% pulmonary artery and coronary sinus. It is found in approximately 0.10% to 0.15% of ronary angiographies and most frequently affects the right scending coronary artery (60%). It is usually found by chance ith no identifiable associated symptoms, but symptoms do pear when the shunt is significant, fundamentally variable grees of ischemia and of heart failure. Dual coronary artery fistulas affecting both coronary territories e extremely rare (5% of the total) and more frequently present enomena of secondary coronary ischemia than of significant ft-right shunt with phenomena of ‘‘coronary steal’’. The rcutaneous approach and coil deployment–which is less 3.