Transcatheter occlusion of a large coronary arterial fistula with new detachable platinum microcoils

We report a 17 year old boy with a large fistula from the right coronary ar tery to the right ventricle. The fistula consisted of two major branches. T he smaller branch could be embolised with three detachable platinum microco ils without problems. The high flow of blood in the larger branch, however, prevented conventional occlusion using coils. Interventional occlusion of this branch was achieved in a second attempt. Following creation of an arte rio-venous wire-loop, we advanced a balloon catheter into the distal end of the fistula. Under temporary occlusion of the fistula, complete closure wa s achieved by delivery of 7 detachable platinum microcoils. Thus, even larg e coronary arterial fistulas can be closed safety with these new platinum d etachable microcoils. The procedure, however, requires temporary control of the flow of blood by balloon occlusion.