TRANSCATHETER EMBOLIZATION OF AN ENLARGING ACQUIRED CORONARY ARTERIOVENOUS-FISTULA IN A HEART-TRANSPLANT RECIPIENT

A 50 year old, recent cardiac transplant recipient developed systolic and diastolic murmurs but remained asymptomatic. The cause of the murm urs was not evident at transthoracic echocardiography. During routine left heart catheterisation a left-anterior descending artery to right ventricular fistula was evident arising from the distal vessel and pre sumably acquired during routine endomyocardial biopsy. One year later, the patient remained asymptomatic but the calibre of the left anterio r descending artery had increased and there appeared to be poor flow i n to the proximal branches. The fistula was successfully treated by pe rcutaneous deployment of two detachable embolisation coils in to the d istal left anterior descending artery.