Cardiovasc Imaging Asia.  2017 Jul;1(3):208-209. 10.22468/cvia.2017.00059.

Angiographical Changes Induced by Tiny Coronary Fistula

• Saigusa T
• Matsuo H
• Suzuki T

• KMID: 2524848
• DOI: http://doi.org/10.22468/cvia.2017.00059

Abstract

An 82-year-old female presented with angina pectoris due to mid-right coronary artery (RCA) stenosis. Percutaneous coronary intervention (PCI) was performed with optical coherence tomography (OCT). When OCT was performed with manual coronary flushing to obtain a clearer image, the contrast media seemed to extravasate from the coronary artery, resembling a coronary perforation; however, the patient did not have any chest pain and her vital signs were stable. Coronary angiography (CAG) performed immediately after the finding showed no abnormalities and the final CAG did not show any abnormalities. Coronary computed tomography angiography after PCI revealed a micro-fistula from the RCA to the right ventricle. With normal injection pressure, contrast did not show the tiny coronary fistula, but it was detectable with high pressure. Our report represents an abrupt angiographical change due to a tiny coronary fistula.

Keyword

Coronary fistula; Percutaneous coronary intervention; High-pressure injection; Coronary computed tomography angiography