Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-185
Device Closure of Left Circumflex Artery to Coronary Sinus Fistula
By Rajeev Bhardwaj
Presenter
Rajeev Bhardwaj
Authors
Rajeev Bhardwaj1
Affiliation
MM Institute of Medical Sciences and Resaerch, Mullana, Ambala, India1,
View Study Report
TCTAP C-185
STRUCTURAL HEART DISEASE - Others (Structural Heart Disease)
Device Closure of Left Circumflex Artery to Coronary Sinus Fistula
Rajeev Bhardwaj1
MM Institute of Medical Sciences and Resaerch, Mullana, Ambala, India1,
Clinical Information
Patient initials or Identifier Number
A K
Relevant Clinical History and Physical Exam
•8yrs female
•Palpitationsince childhood. More on exertion.
•Exertional chest pain for 2 years.
No history of recurrent chest infections in early
childhood.
No history suggestive of rheumatic fever in the past.
Relevant Test Results Prior to Catheterization
X ray chest : Showed cardiomegaly with CT ratio of 55 %.ECG: T inversion in V1 to V3Echocardiography : coronary sinus dilated. Right atrium and ventricle was dilated. Continuous colour flow signals seen in coronary sinus. Continuous wave doppler showed high frequency continuous signals in coronary sinus.
coronary av fistula fig 2.docx
coronary av fistula fig 3.docx
coronary av fistula fig 2.docx coronary av fistula fig 3.docxRelevant Catheterization Findings
Left coronary angiography showed marked dilatation of left main coronary artery and left circumflex coronary artery. Left anterior descending coronary artery was very small.There was flow of contrast from left circumflex coronary artery to coronary sinus through a fistula.
cornay av fistula 1.avi
cornay av fistula 1.aviInterventional Management
Procedural Step
Left coronary was hooked with JL guiding catheter. .018 inch wire was negotiated into the LCx across fistula. But guiding catheter could not be negotiated into the LCx due to obtuse angle of LCx with LAD coronary artery. Then Amplatzer wire was negotiated into LCx, but still catheter could not be negotiated.Now guiding AL1 was taken and wire was crossed into LCx, but still AL1 could not be negotiated into LCx.Finally, we crossed BMW wire into LCx and guideliner extension catheter was negotiated into the LCx. With the support of guide liner, AL1 was negotited into the LCx. Guigeliner was removed. Now the Amplatzer vascular plug of the size of 8 mm was deployed across the fistula. Fistula was completely closed.
cornay av fistula 4.avi
cornay av fistula 6.avi
cornay av fistula 10.avi
cornay av fistula 4.avi cornay av fistula 6.avi cornay av fistula 10.aviCase Summary
•Leftcoronary artery to coronary sinus fistula is a rare
anomaly.
•Patient presents with palpitation and angina.
•LCXand Left many are dilated with decreased flow to
LAD.
•Deviceclosure is challenging and may require multiple
guiding catheter and innovativeideas, as the help of
guideliner in this case.