We report the case of a 4-year-old girl for whom a CAF between the left coronary artery and the right atrium ( Fig. 1A , Video 1 ) was diagnosed at the age of 7 months after echocardiographic exploration of a continuous cardiac murmur. As the patient was asymptomatic, the CAF was not initially closed. Because both the left coronary artery ( Fig. 1B ) and the left ventricle were dilated in the last echocardiograms (10 mm for left coronary artery diameter; 42 mm for left ventricular end-diastolic diameter), percutaneous closure was decided upon. Electrocardiography was normal. Computed tomography revealed a huge CAF (12 mm maximal diameter) originating from the left coronary artery, passing along the left atrial roof ( Fig. 1C ) and draining into the roof of the right atrium ( Fig. 1D ). Transcatheter closure was performed using an anterograde approach. Angiographies accurately showed the horizontal course of this voluminous CAF ( Fig. 2A and 2B , Video 2 ). A vascular plug (diameter, 4 mm) was then deployed in the narrowest portion (diameter, 2 mm) to close the CAF ( Fig. 2C ). Complete occlusion was confirmed by postinterventional echocardiography ( Fig. 2D ). To prevent extensive coronary artery thrombus formation, antiplatelet therapy was prescribed for 6 months. The left coronary artery and left ventricle remained dilated a few weeks after the closure before recovering normal size.
