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Increased pulmonary pressures &#40;mPAP 71<span class="elsevierStyleHsp" style=""></span>mmHg&#44; PVR 5&#46;5 Wood units &#91;WU&#93;&#41; associated with pulmonary hyperflow and significant diastolic dysfunction due to hypertensive heart disease evidenced in the rest of the study data &#40;mean PCP 35<span class="elsevierStyleHsp" style=""></span>mmHg and left ventricular end-diastolic pressure &#91;LVEDP&#93; 25<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; The examination was completed with heart computed tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Transesophageal echocardiography &#40;TEE&#41; showed involvement of right chambers&#44; while the bubble test ruled out intra-cardiac shunt&#46; Diastolic changes with LV parietal hypertrophy and normal LV systolic function were confirmed&#46; Percutaneous closure of the fistula in the proximal&#47;medial segment was performed with 3 coils measuring 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm and 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#46; Occlusion was confirmed immediately with fluoroscopy &#40;Video 2&#44; Appendix&#41;&#44; and subsequently with a follow-up coronary CT one month after the procedure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Follow-up right heart catheterization revealed a marked improvement in mPAP &#40;48<span class="elsevierStyleHsp" style=""></span>mmHg&#41; after resolution of pulmonary hyperflow &#40;cardiac output 4&#46;3<span class="elsevierStyleHsp" style=""></span>l&#47;min and aPVR 4&#46;6 WU&#41;&#44; and persistently elevated PWP and LVEDP associated with the patient&#39;s hypertensive left heart disease &#40;PWP 25<span class="elsevierStyleHsp" style=""></span>mmHg and LVEDP 23<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Coronary artery fistulas are abnormal connections between a coronary artery and one of the heart chambers or one of the vessels located around the heart&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a> Most are congenital&#44; but they may also be acquired&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Coronary artery fistulas are observed in 0&#46;2&#37;&#8211;0&#46;6&#37; of all angiograms&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Most patients are asymptomatic&#59; however&#44; the fistula can sometimes form an arteriovenous short circuit with hemodynamic repercussions&#44; generating heart failure due to volume overload caused by the left-to-right shunt&#44; ischemia due to coronary steal syndrome&#44; fistula rupture or thrombosis&#44; arrhythmias&#44; and infectious endocarditis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In adults it is usually an incidental finding during a coronary angiography&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> as was the case with our patient during the pre-lung transplant study&#46; Some authors recommend closure of the fistula&#44; even in asymptomatic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Reidy et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;3</span></a> performed the first percutaneous closure in 1983&#44; and since then this procedure has been considered an effective and less traumatic option than surgical closure&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Several authors have demonstrated its safety and effectiveness<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> in the management of this disease&#44; reserving surgical closure for multiple or large fistulas&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Several devices have been used for percutaneous closure&#44; the most commonly used being coils and Amplatzer vascular plugs&#46; Amplatzer vascular plugs are usually used in longer&#44; wider fistulas&#44; and coils in smaller fistulas&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> Fistulas usually originate in the left anterior descending artery&#44; followed by the right coronary and circumflex arteries&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;3</span></a> and frequently drain into the pulmonary artery&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Approximately 10&#37; of closures are incomplete or recurrent&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Percutaneous closure of coronary artery fistula prior to lung transplantation is a safe and effective option that reduces the risk associated with volume overload&#44; coronary steal and other complications encountered in patients with this anomaly&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Urmeneta Ulloa J&#44; Molina Borao I&#44; Ochoa Rea ME&#44; S&#225;nchez-Insa E&#46; Embolizaci&#243;n percut&#225;nea en f&#237;stula de arteria coronaria previo al trasplante pulmonar&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;520&#8211;521&#46;</p>"
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            "apendice" => "<p id="par0030" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;</p> <p id="par0035" class="elsevierStylePara elsevierViewall">Coronary angiography&#46; Coronary artery fistula from the LCT to the left pulmonary artery&#46;</p> <p id="par0040" class="elsevierStylePara elsevierViewall">LCT&#58; left common trunk&#46;</p> <p id="par0045" class="elsevierStylePara elsevierViewall">Coronary angiography&#46; Percutaneous closure of a coronary artery fistula with coils&#46;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
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