Diagnosis and Endovascular Treatment of Coronary Artery Fistula: A Case of symptomatic Left-to-Right shunt

Coronary artery fistulas (CAFs) are rare vascular malformations which constitute abnormal communications from coronary arteries to cardiac chambers, or to parts of the systemic or pulmonary circulation.While small CAFs are usually asymptomatic and often resolve spontaneously, medium or large CAFs can result in hemodynamically significant shunting with progressive dilation.We report a case of CAF originating from the right coronary artery and draining into the coronary sinus, which resulted in pulmonary hypertension and heart failure.The patient subsequently underwent percutaneous flow reduction with vascular plug and coils, leading to significant reduction of shunt flow and clinical improvement.CT and procedural fluoroscopic images are provided.