Iatrogenic large coronary artery fistula treated with coronary artery stenting in an 8-year-old child: a case report

Iatrogenic coronary artery fistula, although a rare complication after cardiac surgery, may lead to haemodynamic instability and requires immediate recognition and management. Percutaneous coronary intervention despite its technical challenges is a viable intervention in selected paediatric cases.

We report a case of an 8-year-old child who had cardiac surgery for TOF with pulmonary atresia. The procedure was complicated by a large iatrogenic fistulous communication from left anterior descending artery to right ventricle, ventricular arrhythmias and low cardiac output state. He was salvaged with emergency percutaneous coronary intervention using a covered stent that was successfully deployed across the origin of the fistula, resulting in complete closure of the abnormal communication while preserving normal antegrade coronary flow.

Coronary artery stenting is a technical challenge in paediatric population owing to small calibre vessels. Despite these concerns, it is still a viable option in critical cases with individual case-based approach.