Percutaneous closure of a congenital coronary artery fistula complicated by an acute myocardial infarction.

A coronary artery fistula is not an uncommon finding on a routine coronary angiogram. Small fistulas need no specific treatment, but if haemodynamically important, elective closure is recommended. We present the case of a 69-year-old woman in whom a fistula originating from the right coronary artery and communicating with the right atrium is closed with an Amplatzer VSD occluder. Several hours after a successful closing procedure, the patient developed an acute myocardial infarction. Angiography demonstrated a thrombus that occluded a distal branch of the right coronary artery in the blind pouch of the closed fistula. Urgent bypass surgery was necessary to stabilize the patient's condition. The aim of this case presentation is to warn for complications related to uncommon interventional procedures.