Catheter-based management for the congenital coronary arteriovenous fistula indicated by the stress 99Â mTc-MIBI SPECT

A 10-year-old boy, who had suffered Kawasaki disease 7 years ago, presented chest pain, pale face, and cold sweating in the stress 99 mtechnetium-methoxyisobutylisonitrile (99 mTc-MIBI) single-photon emission computed tomography (SPECT), which showed reversible perfusion abnormality indicative of myocardial ischemia involving the right coronary artery. Angiography identified congenital coronary arteriovenous fistula (CAVF) from the right coronary artery to the main pulmonary artery, to which the patient's symptoms and signs of myocardial ischemia, by means of coronary steal phenomenon that entails reversible perfusion abnormality in the stress 99 mTc-MIBI SPECT, could be ascribed. The penny shall finally be dropped without sudden cardiac event after coaxial transarterial coil occlusion on this boy with the congenital CAVF that is indicated significantly by the stress 99 mTc-MIBI SPECT.