Aortic Valve (TAVR/TAVI)JACCMonday, October 19, 2026

Tortuous Coronary Artery Fistula Closed Using a Microvascular Plug in Heart Failure.

1 min read·By E. Nolan Beckett, MD·Source: JACC. Case reports

Key Numbers

20%

25% with apical and anterior

40%

45% and complete resolution of

From The Valve Wire

A 74-year-old woman with an EF of 20% to 25% and apical/anterior akinesis had a large LAD-to-pulmonary artery fistula closed with a 5-mm vascular plug delivered through a microcatheter after multiple conventional closure attempts failed against nearly 180-degree bends.

Follow-up echocardiography showed EF recovery to 40% to 45% and resolution of the wall motion abnormalities.

The mechanism is coronary steal, and the recovery is the proof of concept.

Single-case EF recovery after any intervention carries the usual confounders: concurrent medical therapy optimization, interobserver variability in visual EF estimation, and the absence of a pre-specified imaging protocol.

Source Abstract

BACKGROUND: Large coronary artery fistulas may result in ischemia and heart failure. CASE SUMMARY: A 74-year-old woman was found to have an ejection fraction of 20%-25% with apical and anterior akinesis. A large fistula from the left anterior descending artery to the pulmonary artery was identified as the likely etiology. Multiple attempts at closure failed in the setting of extreme tortuosity with nearly 180° bends. Eventually, a 5-mm vascular plug was advanced through a microcatheter and successfully deployed. Follow-up echocardiography demonstrated improvement of the ejection fraction to 40%-45% and complete resolution of the previous wall motion abnormalities. DISCUSSION: This case illustrates a reversible coronary steal-mediated cardiomyopathy. It highlights the clinical utility of microcatheter-compatible vascular plugs for transcatheter closure of anatomically complex coronary fistulas, even in elderly patients. TAKE-HOME MESSAGE: Percutaneous closure of coronary artery fistulas with microcatheter-compatible devices improves cardiac function even in elderly patients.