Treatment of multiple residual complex coronary to right ventricular fistulae with covered stents following previous coil embolization.

Congenital coronary artery fistulae may be isolated or may be associated with complex congenital cardiac abnormalities. In patients with complex congenital heart disease, multiple fistulous or sinusoidal communications with a cardiac chamber can occur. The treatment strategy includes surgery, coil embolization and covered stent deployment. The present article describes a case involving a 20-year-old patient with complex congenital heart lesions and multiple sinusoidal coronary to right ventricle fistulous communications, which remained patent despite coil embolization in childhood. Further coil or device embolization was deemed unlikely to be successful due to the presence of multiple communications; therefore, covered stents were deployed across the previously coiled segment of the coronary artery. The patient had an excellent clinical outcome on follow-up nine months later, with significant improvement of symptoms.