We describe the case of a 3.5-year-old-girl with large coronary fistula that originated from the proximal left coronary artery and, after a tortuous distal course, drained into the right atrium. The narrowest fistula diameter was 6.7 mm. Fistula was successfully closed with a 12-mm Amplatzer vascular plug type 1 using a retrograde approach without creating an arteriovenous loop. Femoral artery damage that required thrombolytic (streptokinase) therapy was observed after the procedure. Retrograde approach does not require creation of an arteriovenous loop. However, potential benefits have to be considered in the light of potential peripheral artery damage and subsequent thrombolytic therapy.
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