Percutaneous closure of a giant coronary artery fistula draining into superior vena cava

Coronary artery fistulas are rare coronary anomalies; coronary angiography remains the gold standard for the diagnosis, and is essential to plan either surgical or percutaneous intervention. The use of an Amplatzer Vascular Plug device in percutaneous closure of coronary fistulas has been recently described in a few cases of paediatric age patients, with positive results, but has never been reported in adult patients. We report the case of a 36-year-old female, with an unusually large right coronary artery fistula draining into superior vena cava that was successfully closed percutaneously, using a 14 mm Amplatzer device (Vascular Plug II, AGA). We also discuss our therapeutic option, since management of large, asymptomatic fistulas, is still a matter of debate, although most authors tend to recommend its closure.