Heart and Vessels

, Volume 31, Issue 5, pp 816–818 | Cite as

Fractional flow reserve-guided percutaneous coronary intervention for an intermediate stenosis complicated by a coronary-to-pulmonary artery fistula

  • Tsuyoshi Ito
  • Shunsuke Murai
  • Hiroshi Fujita
  • Tomomitsu Tani
  • Nobuyuki Ohte
Case Report

Abstract

A 65-year-old man was referred to our hospital following repetitive chest pain. Invasive coronary angiography showed an intermediate stenosis of the proximal left anterior descending artery (LAD), and a coronary fistula originating distal to the stenosis draining into the main pulmonary artery. To evaluate the functional abnormality arising from the stenosis and coronary steal due to the fistula, fractional flow reserve (FFR) was measured using a pressure wire with pullback recording. The FFR value was 0.74 at the distal LAD, 0.78 distal to the fistula, 0.81 proximal to the fistula (distal to the stenosis), and abruptly increased to 1.0 proximal to the stenosis. Based on these FFR results, percutaneous coronary intervention was performed to the stenosis. After stent placement, the FFR value improved to 0.87 at the distal LAD, and no abrupt pressure gradient was observed beyond the fistula and the stent. FFR-guided intervention with pullback pressure recording could be a useful and practical method to apply in cases with coronary stenosis complicated by coronary fistula in the same vessel.

Keywords

Coronary fistula Coronary artery stenosis Functional evaluation Fractional flow reserve 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Tsuyoshi Ito
    • 1
  • Shunsuke Murai
    • 1
  • Hiroshi Fujita
    • 1
  • Tomomitsu Tani
    • 1
  • Nobuyuki Ohte
    • 1
  1. 1.Department of Cardio-Renal Medicine and HypertensionNagoya City University Graduate School of Medical SciencesNagoyaJapan

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