Coronary artery fistula

Selective left coronary artery (LCA) angiogram (panel A) demonstrates the termination of a fistula (arrow) from the diagonal branch of the left anterior descending (LAD) artery to the right ventricle (RV). A small amount of flow is noted in the distal LAD (arrowhead). Panel B shows the deployment of Gianturco coil (arrow) at the terminal end of the fistula; in panel C a second Gianturco coil is placed (arrow). Selective LCA angiogram soon after coil deployment (panel D) shows a small residual shunt (arrow). However, a repeat selective LCA angiogram obtained 10 minutes later demonstrates no residual shunting through the coils (panel E); there is increased flow into the distal LAD (arrow) after elimination of coronary artery steal through the fistula. Selective LCA angiogram in the lateral view (panel F) confirms the absence of residual shunting through the coils (arrow) and increased flow to the distal LAD (arrowhead).