Cardiac arrest due to acute thrombosis after surgical closure of coronary fistula: the role of anticoagulation

Described herein the case of a 47-year-old woman who underwent surgical closure of a large fistula between the right coronary artery (RCA) and the superior vena cava with subsequent thrombosis of the ectatic RCA determining myocardial infarction and cardiac arrest. After resuscitation, rheolitic thrombectomy with AngioJet device was performed and anticoagulant treatment was started in addition to antiplatelet therapy. The type of antithrombotic therapy after coronary fistula closure is still debated but long-term anticoagulation should be considered in high-risk cases.