Transcatheter embolization in the treatment of coronary artery fistulas

Abstract

Seven patients with a coronary artery fistula underwent percutaneous transcatheter embolization (five were male and two female; the age range was 2 to 67 years [median 17]). Three patients were symptomatic. The left to right shunt ranged from 1.6 to 2.6:1. In six patients, the fistula was an isolated congenital anomaly; in one, it was acquired. The fistula arose from branches of the left (n = 5) and right (n = 2) coronary arteries and drained to the right ventricle (n = 2), right atrium (n = 2), coronary sinus (n = 1), pulmonary artery (n = 1) and a bronchial artery (n = 1). Different embolization techniques were used to occlude eight feeding arteries. The embolization materials included a detachable balloon (n = 3), coaxial embolization with platinum microcoils (n = 3), a combination of detachable balloon and microcoil (n = 1) and standard steel coils (n = 1). Satisfactory occlusion was achieved in six patients. In one case, the valve of the detachable balloon was damaged, resulting in early balloon deflation and a residual fistula. There were no associated complications in any patient. Follow-up investigation by Doppler ultrasound or coronary angiography 4 months to 4 years later showed that permanent occlusion was achieved in all six patients in whom embolization was initially successful. Transcatheter embolization should be considered the treatment of choice for coronary artery fistulas.

Pathophysiology of Congenital Heart Disease in the Adult

“…Surgical closure usually is performed on a beating heart from the epicardial surface, is associated with low mortality and morbidity, and has excellent immediate and long-term outcomes. 81 Various transcatheter occlusion techniques have been used [82][83][84] with excellent outcomes for fistulas with shorter, less tortuous courses.…”

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

“…3,16,17) Although several complications such as T-wave inversion on an electrogram, embolization of the coil to the pulmonary artery, and transient arrhythmias were experienced in 30% of patients, 3,16) complete closure of CAVF was obtained in 78% to 82% of patients by transcatheter embolization. 3,17) However, a retrospective review to determine the comparative therapeutic efficacy of operation and coil embolization showed that coil embolization was possible, at most, in 6 (38%) of 16 patients, 16) and has indicated that the requirements for satisfactory coil embolization of a CAF include the ability to safely cannulate the branch coronary artery that supplies the fistula, the absence of large branch vessels that can be inadvertently embolized, the presence of a single, narrow restrictive drainage site into the cardiac chamber or vessel, and the absence of multiple fistulous connections. 3,16,17) According to these results, transcatheter embolization is considered to be a reasonable alternative to standard surgical closure in a selected group of patients.…”

Transcatheter Coil Embolization of a High-Flow Coronary Artery Fistula Using 0.052-Inch Gianturco Coils-A Case Report-

“…Therefore, the actual successful rate for coil embolization is lower than expected and in order to obtain a reliable outcome, the indication must be strict, as outlined by Mavroudis et al: (1) able to safely cannulate the branch coronary artery that supplies the fistula, (2) absence of large branch vessels that can be inadvertently embolized, (3) presence of a single, narrow, restrictive drainage site into the cardiac chamber or vessels, and (4) absence of multiple fistulous communications. 6 Fortunately, the present case had all these requirements.…”