Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach

Firouzi, Ata; Alemzadeh‐Ansari, Mohammad Javad; Mohebbi, Bahram; Khajali, Zahra; Khalilipur, Ehsan; Baay, Mohammadreza; Bayatian, Ayatollah; Taherian, Maisam; Khosropour, Amir; Hosseini, Zahra

doi:10.1016/j.cpcardiol.2021.101010

Cited by 10 publications

(6 citation statements)

References 26 publications

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“…Clinical presentation generally depends on the hemodynamic significance of CCFs. A CCF that drains to the right cardiac chambers creates a left-to-right shunt, which can lead to volume overload and congestive heart failure [5]. A CCF that drains to the left ventricle (LV) produces hemodynamic changes similar to those of aortic regurgitation, and a CCF that drains to the left atrium (LA) results in volume overload similar to that of mitral regurgitation [6].…”

Section: Introductionmentioning

confidence: 99%

Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

Li,

Chen,

Xie

et al. 2023

Congenital Heart Disease

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Background: Limited data are available regarding intermediate and long-term outcomes of transcatheter closure (TCC) of coronary cameral fistulas (CCFs) in the pediatric patients. Methods: All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study. Results: A total of 66 patients (median age: 3.93 years, median weight: 15 kg) underwent attempted TCC of CCFs. Immediate successful device implantation was achieved in 62 patients, and immediate complete occlusion was achieved in 44 patients (44/62%, 71.0%). The closure procedure was waived in 2 patients due to anatomical factors. A total of 6 periprocedural complications occurred in 5 patients, including acute myocardial infarction (n = 3), procedure-related death (n = 1), device embolization (n = 1), and rupture of tricuspid chordae tendineae (n = 1). The acute procedural success rate was 89.4% (59/66), while the acute complication rate was 9.1% (6/66). Follow-up data were collected for 58 (93.5%) out of 62 patients at a median of 9.3 years (range: 3.0-15.7 years). 10 adverse events occurred in 9 patients, including 5 follow-up complications (1 aortic valve perforation, 1 coronary thrombosis, 1 progressive aneurysmal dilation after reintervention, and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation), and 5 closure failure with large residual shunts. The intermediate and long-term adverse event rate was 17.2% (10/58). The anatomical features associated with both acute and follow-up adverse events were large CCFs (p = 0.005), and giant coronary artery aneurysms (CAAs) (p = 0.029). Conclusions: TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate. Large CCFs and giant CAAs represent a higher risk of both acute and intermediate and long-term adverse events after closure.

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Section: Introductionmentioning

confidence: 99%

Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

Li,

Chen,

Xie

et al. 2023

Congenital Heart Disease

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“…However, with age, clinical symptoms gradually occur, such as exertional dyspnea, chest pain, infective arteritis, etc. ( Firouzi et al, 2021 ). If combined with coronary arteries dilation or aneurysms, it may cause serious complications such as acute myocardial infarction, cardiac failure, rupture, arrhythmias, etc ( Qureshi, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The treatments of CAF mainly include surgical ligation, transcatheter closure (TCC) and drug therapy ( Kilic et al, 2008 ; Akcay et al, 2009 ; Jama et al, 2011 ; Centella et al, 2016 ; Haweleh et al, 2018 ; Firouzi et al, 2021 ). A recent study proposed that in patients with medium‐ to large-sized fistulas, irrespective of symptoms, closure (either surgical ligation or TCC) is recommended ( Firouzi et al, 2021 ). The common method is to occlude the terminal of the fistula, while retaining small branches to maintain the blood supply of the myocardium ( Kilic et al, 2008 ; Jama et al, 2011 ) and improve the phenomenon of stealing blood.…”

Section: Introductionmentioning

confidence: 99%

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A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model

et al. 2022

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Objective: The aim of this study is to numerically evaluate thrombosis risk within occluded coronary arterial fistulas (CAF) with terminal aneurysms, and provide guidance in choosing occlusion positions, with clinical observations as reference.Method: Four patients with CAF were studied, with different occlusion positions in actual treatments. Hemodynamics simulations were conducted, with blood residue predicted using the blood stasis model. Three types of models (untreated model, aneurysm-reserved model and aneurysm-removed model) were studeid for each patient. Four metrics, i.e., proportion of high oscillatory shear index (OSI), area of high OSI, old blood volume fraction (OBVF)) and old blood volume (OBV) was obtained to distinguish the thrombosis risk of different treatments (proximal or distal occlusion), comparing with the follow-up CTA.Results: For all the postopertive models, the high OBVF, high OSI(>0.3) and low time-averaged wall shear stress (TAWSS) regions were mainly at the distal fistula, indicating these regions were prone to thrombosis. The regions where blood residue remains are roughly regions of high OSI, corresponding well with clinical observations. In contrast, TAWSS failed to distinguish the difference in thrombosis risk. Absolute values (area of high OSI, OBV) can better reflect the degree of thrombosis risk between treatment types compared with percentage values (proportion of high OSI, OBVF). By comparing with the actual clinical treatments and observations, the OBV is superior to the area of high OSI in determining treatment type.Conclusion: The OBV, a volumetric parameter for blood stasis, can better account for the CAF thrombosis and reflect the degree of blood stasis compared with OSI or TAWSS, is a more appropriate metric for thrombosis in the fistula. Together with morphological parameters, the OBV could guide clinicians to formulate more appropriate surgical plans, which is of great significance for the preoperative evaluation and treatment prognosis of CAF patients.

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“…Small fistulae are often asymptomatic, and may even close gradually. Small CCFs in general can be monitored with echocardiographic or angiographic follow-up to detect the expansion of feeding vessels with time [ 5 ].…”

mentioning

confidence: 99%

Management of right coronary-cameral fistula in a young woman presenting with ischemic symptoms

Darbari¹,

Singh²,

Rawat³

et al. 2023

kitp

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Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach

Cited by 10 publications

References 26 publications

Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model

Management of right coronary-cameral fistula in a young woman presenting with ischemic symptoms

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