Coronary artery fistula occluder

Selective left coronary artery angiogram shows a dilated left circumflex coronary artery (LCx) with a fistula (arrow) to the right atrium (RA). Panel B shows a selective LCx coronary angiogram via a sheath (arrow) introduced from the inferior vena cava to the LCX through the fistula. Note the patency of the last viable myocardial branch of the LCX (arrowhead). Panel C shows a selective left coronary artery angiogram after the placement of an occlusion device (arrow); there is no residual shunting to the RA through the device. Note that the last viable myocardial branch remains patent (dashed arrow) and that there is enhanced blood flow to the other coronary artery branches after elimination of the steal (arrowhead).