Percutaneous treatment of iatrogenic left-anterior descending artery to right ventricle fistula.

Iatrogenic coronary fistula is a rare condition whose treatment strategy is not well established. We report the case of a 70-year-old patient who came to our attention with echocardiographic and scintigraphic signs of myocardial ischemia and who had undergone heart transplantation 10 years earlier. The coronary angiogram showed a coronary fistula connecting the left-anterior descending artery to the right ventricle via an enlarged septal branch. Because of the presence of myocardial ischemia, the patient was scheduled for percutaneous coronary intervention. The fistula was sealed with implant of two polytetrafluoroethylene (PTFE)-covered stents that excluded the septal branch. One-year follow-up showed persistence of the good result in terms of angiographic and clinical outcome.