Remodeling and thrombosis following closure of coronary artery fistula with review of management

“…The transcatheter and surgical approaches have similar early effectiveness, morbidity, and mortality [3,28,29,48]. Sequelae after closure of the fistula include persistent coronary dilatation, residual leak, thrombosis with or without myocardial infarction, and coronary stenosis with perfusion defects [49,54]. Patients who undergo a closure procedure have a recurrence rate of up to 20-30% [3,49].…”

Section: Prognosis and Late Complicationsmentioning

confidence: 99%

“…Follow-up angiography has shown a high incidence of occlusion of the parent coronary artery when the fistula arises from the native artery (distal fistulas) and not from one of its branches (proximal fistulas) [49]. The large, distal type of CAFs appears to be at the highest risk for coronary thrombosis [34,49,54]. This might be due to dilatation of the coronary artery proximal to the fistula and a risk of blood flow stasis and thrombosis after CAF closure [34].…”

Section: Prognosis and Late Complicationsmentioning

confidence: 99%

Coronary Artery Fistulas: Case Series and Literature Review

Karazisi

Eriksson²,

Dellborg³

2016

Cardiology

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Congenital coronary artery fistulas are rare anomalies. As coronary angiography and multidetector computed tomography have become more accessible, they have been increasingly used in the investigation of chest pain and heart failure. Coronary artery fistulas are often an incidental finding, which raises the question of how patients with this condition should be managed. Intervention with either transcatheter closure or surgical closure is often technically possible. Many patients are asymptomatic early after closure. However, follow-up studies have shown post-closure sequelae, such as residual leakage, thrombosis with or without myocardial infarction, and coronary stenosis. Therefore, there has been a shift from intervention towards watchful waiting in asymptomatic patients. In this article, we review the published literature on the natural history and treatment outcomes in individuals with coronary artery fistulas. We present case reports from our clinic and discuss the management of incidental findings of coronary artery fistulas.

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“…(22) Long term anticoagulation is advisable for patients with persistent coronary artery dilatation. (19,23,24) Warfarin is recommended for the first 6 months to a year, followed by antiplatelet medication indefinitely. (24) …”

mentioning

confidence: 99%

“…(19,23,24) Warfarin is recommended for the first 6 months to a year, followed by antiplatelet medication indefinitely. (24) …”

mentioning

confidence: 99%