Transcatheter closure of a large congenital LCX–RA coronary fistula using a PDA occluder: Case insights and literature review

Coronary artery fistulas (CAFs) are rare coronary anomalies that are often incidental findings but may cause significant hemodynamic consequences when large or symptomatic. We report the case of a 24-year-old man in whom a congenital CAF originating from the proximal left circumflex artery (LCX) and draining into the right atrium (RA) was incidentally detected during a routine occupational health evaluation. Transthoracic echocardiography demonstrated left-sided chamber enlargement consistent with volume overload, while coronary computed tomography angiography and invasive angiography delineated the large, tortuous fistulous tract. Based on these findings, percutaneous transcatheter closure was performed using a 14 × 18 mm Amplatzer™ patent ductus arteriosus (PDA) occluder device under transesophageal echocardiographic guidance. Immediate and follow-up imaging confirmed near-complete occlusion with minimal residual flow and no complications. This case highlights the role of multimodality imaging in guiding diagnosis and treatment planning, and demonstrates that transcatheter closure is a safe and effective therapeutic option for hemodynamically significant CAFs.