Transcatheter Closure of Congenital Coronary Artery Fistulae: Immediate and Long‐Term Follow‐Up Results

Abstract

BackgroundTranscatheter closure of coronary artery fistulae (CAF) has emerged as an alternative to surgery, but there are no long‐term outcome results.ObjectiveWe report immediate and long‐term results in 24 patients after transcatheter closure of congen‐ ital CAF.MethodsA total of 24 patients aged 5 to 56 years old with congenital CAF underwent attempted percutaneous transcatheter closure using various devices between November 1998 and August 2008. The immediate closure results and clinical follow‐up were reviewed.ResultsOf the 24 patients, 20 (83.3%) underwent successful transcatheter closure using various devices. An angiogram right after device deployment revealed complete occlusion in 15 patients (75%) and trivial‐ to mild‐ residual flow in 5 patients (25%). Four patients (20%) had transient ST‐T wave changes after the procedure. The left ventricular end‐diastolic volume decreased from 165±31.4 mm3 to 128.6±24.4 mm3 (P = 0.012) 24 hours after procedure, and the cardiothoracic ratio from 0.57±0.02 to 0.53±0.01 (P = 0.003). Follow‐up was 100% complete and ranged from 3 months to 10 years. There were no early or late deaths. All patients were asymptomatic with complete closure of CAF except 1 patient (5%) who had a recurrence of shunt at 6‐month follow‐up, which was re‐closed by percutaneous technique.ConclusionTranscatheter closure of CAF is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients. Copyright © 2009 Wiley Periodicals, Inc.

Percutaneous closure of congenital coronary artery fistulae in 5 children: A single center experience

“…Residual or recurrent shunts after transcatheter closure have been reported in 10-20% of patients and these may require further procedures to achieve complete occlusion. 24,26 A study shows that an incidence of major complications which occurs late after closure of CAFs with transcatheter and surgical interventions is 15%, reported by Valente et al 27 Mortality related to surgical closure or transcatheter closure of isolated CAFs is low (<1%) 20,28 In our study, CAF closure was attempted percutaneous occlusion in all the 5 cases & used three different devices; VAD occluder, PDA Occluder and detachable Cook coil to close the lesions. Among 5 patients, we approached percutaneous CAF closure though venous approach in 4 cases with and only one through arterial approach.…”

“…None had follow-up angiograms. Recently, Zhu et al 24 reported transcatheter closure results of 24 patients. All had clinical follow-up ranging from 3 months to 10 years.…”

Coronary Arteriovenous Fistula

“…Various occlusion devices are available for the closure of the CAFs. These are Gianturco and polyester-covered stainless steel coils, detachable balloons, umbrella devices, covered stent polyvinyl alcohol particles, glue and a combination of these instruments (Tacoy et al, 2009;Zhu et al, 2010). The above mentioned coils are used primarily in smaller CAFs (Figure-8).…”

“…Compared with umbrella devices, the plug affords greater opportunity to close the tortuous fistulae as it can be delivered through a flexible guiding catheter. Detachable coils can also be delivered through a guiding catheter, however, it seems that the plug has advantages over the detachable coil in ease of delivery and incidence of residual flow (Zhu et al, 2010). Double umbrella devices allow more precise positioning and are used in larger fistulae with coronary branches close to the occlusion site ( Figure-9) (Armsby et al, 2002).…”

“…Afterwards, heparin needs to be administered (100 units/kg). After hemodynamic data is obtained, aortic root angiography and selective coronary angiography are performed in order to demonstrate the anatomy of the fistula, its drainage site, and in order to identify distal coronary branches (Zhu et al, 2010). Coronary angiograms are analyzed using different systems and the diameter of the fistula is measured.…”