ABC | Volume 110, Nº3, March 2018

Clinicoradiological Correlation Atik et al Percutaneous closure of the coronary-cavitary fistula Arq Bras Cardiol. 2018; 110(3):289-291 Figure1 – Chest X-rays before (left) and 5 years after (right) coronary-cavitary fistula occlusion, highlighting the decrease in heart size (slightly enlarged before procedure). Figure 2 – Coronary cineangiography showing important dilation of right coronary artery (RCA), emerging from the circumflex artery and terminating in the aneurysmal compartment (A and B). Drainage of aneurysm in the final segment of RCA was conducted in the right ventricle (RV). Insertion of the Amplatzer vascular plug II (arrow) from the RV can be seen in RCA, in the segment anterior to the coronary aneurysm (D) and interruption of the fistula drainage (E). Cx: circumflex; Di: diagonalis; AD: anterior descending artery. cavities. These fistulas may be simple or multiple, and cause a proportional volume overload, mimicking conditions including interatrial communication, interventricular communication and arterial channel persistence, depending on the drainage site. In addition, they cause myocardial ischemia, arrhythmias, vascular rupture, and endocarditis. Therefore, and effective treatment of these fistulas is paramount, and has been performed by surgery or by interventional catheterization since 1983. 1 Positive results of both procedures overcome complications which include infarction, prosthesis embolization, fistula dissection and arrhythmia. Indication for percutaneous intervention increases in face of a faster recovery, lower morbidity and lower cost. It is of note that coronary artery dilation is not reduced even after fistula resolution, which reflects the presence of concomitant lesion of elastic fibers of the vessel, that surpasses its limits of distensibility. 290