TITLE:
Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure
AUTHORS:
Pablo Díez Villanueva, Fernando Sarnago Cebada, Enrique Gutiérrez Ibañes, Ricardo Sanz-Ruíz, Jaime Elízaga-Corrales, Francisco Fernández-Avilés
KEYWORDS:
Giant Coronary Fistula; Circumflex Coronary Artery; Coronary Sinus; Percutaneous Transcatheter Closure; Pericardial Effusion; Cardiac Tamponade
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.2,
April
25,
2013
ABSTRACT: We present the case of an
unusual complication after percutaneous closure of a giant coronary artery fis-tula. A
76-year-old man with previous admissions due to right heart failure and
previous history of atrial fibrillation under acenocumarol, was admitted to our hospital for new onset of symptoms, characterized by progressive dyspnoea and peripheral edema. Physical examination revealed
signs of congestive heart failure and a
continuous murmur loudest along the lower sternal border. X-Ray showed cardiomegaly due to right chambers
dilatation. Transthoracic echocardiography showed right chambers pressure
and volume overload, with right ventricular enlargement and dysfunction,
tricuspid annulus dilatation and severe tricuspid
regurgitation. Cardiac catheterization showed significant elevation of right atrial pressure, as well as significant
step-up of oxygen saturation in this chamber. Coronary angiography revealed the
presence of a large fistula between the circumflex coronary artery (CCA) and
coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm).
An Amplatzer? PDA was implanted in a distal elbow of the fistula
with initailly good results. Anticoagulant therapy was then reinitiated, and a
few days later, the patient developed clinical worsening of heart failure and
dyspnoea. Echocardiogram showed significant
pericardial effusion. Pleuropericardial window was then made draining
a500 cm3 of bloody
pericardial effusion. The postoperative outcome was excellent, with symptomatic
relief and no signs of heart failure.