The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience

Abstract

Background: Due to the low prevalence, the optimal treatment strategy of coronary-pulmonary artery fistula (CPF) remains unclear, and there are no established therapeutic guidelines available. The purpose of this study is to investigate the characteristics of CPF, and evaluate the effectivity of trans-catheter closure (TCC) for CPFs. Methods: Patients with CPFs were retrospectively reviewed and enrolled according to the inclusion criteria. The data of clinical manifestations, physical signs, electrocardiogram (ECG), echocardiography, coronary CTA, coronary angiography and intervention procedure were collected. The telephone follow-up was conducted to evaluate the prognosis. Results: The most common presenting complaint was dyspnea (n=21, 48.84%), followed by chest pain (n=10, 23.36%), palpitation (n=6, 13.95%), dizziness (n=3, 6.98%), and syncope (n=3, 6.98%). Most patients were coupled with single fistula (n=17, 39.53%) or two fistulas (n=23, 53.49%). Thirty fistulas (41.67%) involved the left anterior descending (LAD) artery, 28 fistulas (38.89%) involved the right coronary, 9 fistulas (12.50%) involved the left main trunk, and 5 fistulas (6.94%) involved the circumflex branch. Most of the fistulous tracts originated within the proximal one-third of the coronary arteries, only 6 fistulous tracts (8.33%) originated from the distal segment of the coronary arteries. The size of fistulas arranged from 1 mm to 8 mm, with an average of 3.45 mm. Thirty-five patients (81.40%) with 63 fistulas (87.50%) were successfully treated by percutaneous transcatheter closure. Thirty-eight patients accepted the 6-month follow-up, 36 patients (94.74%) were asymptomatic and 2 patients (5.26%) with palpitation. In conclusion, patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs. Conclusions: patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs.

Transcatheter closure of coronary artery fistula: A 21‐year experience

“…[7][8][9][10] Small single-center studies have suggested that transcatheter CAF closure is associated with a high rate of procedural success (82-93%) and relatively low morbidity in select patients. 7,8,12 Similar rates of procedural success and complications were observed in a multicenter series. 13 In the current study, procedural success occurred at a comparable rate (89.3%).…”

“…Since first performed in 1983 by Reidy et al, considerable advancements in transcatheter CAF closure technique and devices have been made leading to a significant increase in procedural success . Small single‐center studies have suggested that transcatheter CAF closure is associated with a high rate of procedural success (82–93%) and relatively low morbidity in select patients . Similar rates of procedural success and complications were observed in a multicenter series .…”

Computed tomography angiography diagnosis of the accessory right coronary artery-pulmonary artery fistula: a case description

“…This phenomenon is also known as "coronary blood stealing (4)." Severe coronary pulmonary fistula can even lead to acute myocardial infarction, heart failure, malignant arrhythmia and sudden death (5). Therefore, the early and accurate diagnosis of coronary artery-pulmonary fistula has important clinical significance.…”

Steal and strain: A case of coronary artery fistula presenting with coronary steal syndrome and underlying bronchiectasis

“…A Dutch study reported that cases with proximal fistulas, fistulas with termination away from the normal coronary artery, and older individuals are ideal candidates for PTE [ 20 ]. In contrast, those with larger fistulas, multiple fistulas, associated cardiac disease requiring surgical management, failure of PTE, tortuous fistulas, and large aneurysms are ideal candidates for surgical ligation [ [21] , [22] ]. In our case, we attempted PTE for treatment of the fistula, but unfortunately the procedure was unsuccessful due to the inability to enter the distal end of the fistula, which is known to happen in up to 6% of patients [ 21 ].…”