Coil embolization of coronary artery fistulas. A single-centre experience

Kabbani, Zuheir; García-Nielsen, Luis; Lozano, María Luisa; Febles, Tomas; Febles-Bethencourt, Luis; Castro, A. Franco de

doi:10.1016/j.carrev.2007.06.001

Cited by 20 publications

(22 citation statements)

References 25 publications

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“…With these advanced diagnostic techniques many unilateral [10][11][12][13][14][15] , bilateral [16][17][18][19][20] and multilateral [21] fistulas have been diagnosed. Many reports from various parts of the world recording congenital CAFs in adults have been published during the last decade [22][23][24][25][26][27][28] . The pertinent diagnosis of congenital CAFs in adults has been published from different regions of the world [29][30][31][32][33][34][35][36] .…”

Section: Introductionmentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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AIM:To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS:A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multislice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION:Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

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Section: Introductionmentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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“…Successful transcatheter closure of a coronary artery fistula was first reported in 1983 (21). Since then, this treatment method has become more popular and is now widely avail- able (6,7,9,(18)(19)(20). Because of the low prevalence of coronary artery fistulas, the optimal management remains unclear and there are no established therapeutic guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, we successfully performed percutaneous coil embolization even though the fistula was large and tortuous. Recent improvements in endovascular techniques and devices have resulted in the increased use of percutaneous intervention for the noninvasive treatment of coronary artery fistulas (6,7,9,(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…Coronary artery fistulas can result in heart failure (4-7), myocardial ischemia (4,6,(8)(9)(10), endocarditis (11) and rupture of aneurysmal vessels (12)(13)(14). The majority of coronary artery fistulas originate from the right coronary artery or left anterior descending artery (LAD) and connect with a pulmonary artery, pulmonary vein, cardiac chamber, coronary sinus or the vena cava (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

et al. 2013

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We herein report the case of a 73-year-old woman with a large and tortuous coronary artery to pulmonary artery fistula treated with percutaneous coil embolization. The patient was hospitalized due to unstable angina with an elevated serum troponin-T level. Coronary angiography revealed no significant atherosclerotic stenosis, with a large and tortuous coronary artery to pulmonary artery fistula originating from the proximal portion of the left anterior descending artery. We successfully performed percutaneous coil embolization of the fistula. In this case, 320-slice multidetector computed tomography played a pivotal role in the diagnosis and percutaneous intervention.

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“…The main indications for closure are clinical symptoms, most particularly heart failure and myocardial ischemia, and in asymptomatic patients with high-flow shunting, to prevent occurrence of symptoms or complications, especially in the pediatric population [9]. Currently, percutaneous treatment is proposed as the first choice because it is less radical and entails a shorter period of hospitalization; surgery is reserved for cases of multiple fistulae, those affecting large branches during embolization of coils, or when the fistulous connection is narrow, restrictive and draining into a cardiac chamber [10,11].…”

Section: Lad Left Anterior Descending Arterymentioning

confidence: 99%

A case of type I dual left anterior descending coronary to pulmonary artery fistula

Çelik

Ağaç

2010

Open Medicine

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Coil embolization of coronary artery fistulas. A single-centre experience

Cited by 20 publications

References 25 publications

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

A case of type I dual left anterior descending coronary to pulmonary artery fistula

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