Cardiovascular Conditions in Patients awaiting Renal Transplantation

Pre-operative optimization of cardiovascular conditions in patients awaiting renal transplantation significantly improves post-transplantation cardiac complications. We describe a case of symptomatic coronary fistula treated with percutaneous coil embolization in a young adult awaiting renal transplantation. A 28-year-old male presented for a pre-operative assessment in preparation for renal transplantation. He reported intermittent exceptional chest pain for the last 6 months. Vital signs were within normal limits and physical examination findings were remarkable only for an arteriovenous dialysis fistula. He had a history of medullary cystic kidney disease type 1 complicated by end-stage renal disease requiring haemodialysis for the previous 6 years. A regadenoson nuclear stress test result revealed a moderate zone of inferior wall myocardial ischemia. Coronary angiography revealed a right-dominant system with a large Coronary Artery Fistula (CAF) originating from the cones branch of the right coronary artery with a superior take-off to the pulmonary artery Angiography did not demonstrate coronary artery disease. It was decided to pursue percutaneous coil embolization of the CAF. After multiple Azure Cu peripheral coils (Terumo, Somerset, New Jersey) were successfully deployed, the CAF was sealed, and the patient was discharged home with a prescription of aspirin (81 mg) for 30 days He underwent successful non-living-donor renal transplantation 2 months after, with no perioperative cardiovascular complications at the 2-month follow-up.

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