• Wei-Chieh Lee, Hsiu-Yu Fang, Chien-Fu Huang, and Chih-Yuan Fang.
• Division of Cardiology, Department of Internal Medicine.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13747.

RationaleCoronary artery fistulae (CAF) are uncommon heart lesions, but they are the most frequent significant hemodynamic congenital coronary anomaly. Transcatheter closure is an alternative treatment and a variety of techniques and devices were reported to use for the closure of congenital coronary fistulae.Patient ConcernsWe reported a 5-year-10-month-old boy who was diagnosed as CAF at birth. Follow-up transthoracic echocardiography showed persistent CAF and progressed dilatation of the left coronary artery.DiagnosesCoronary angiography showed torturous coronary vessel and CAF at the distal segment of the left circumflex artery (LCX).InterventionAntegrade approach with Amplatzer Vascular Plug was used due to the retrograde approach failed and showed a good result.OutcomesDuring a 3-year follow-up period, the patient showed no symptoms and demonstrated good exercise ability. Follow-up coronary angiography showed the Amplatzer vascular plug was located at an adequate position without a residual shunt from the CAF, and the diameter of the left coronary artery regressed when compared to previous angiography results.LessonsThe antegrade approach is a feasible method for closing CAF if torturous vessels are noted and fistulae occur at the distal portion of the coronary artery. A large randomized study or case series are needed to investigate the comparison of antegrade and retrograde method for the closure of CAF.

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