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Catheter-based techniques for closure of coronary fistulae
G Dorros1, V Thota, K Ramireddy
1William Dorros--Isadore Feuer Interventional, Cardiovascular Disease Foundation, Milwaukee, Wisconsin, USA. gdorros@asheart.com
Insights
Percutaneous closure of coronary fistulas using transcatheter methods is effective for most patients. However, a rare but serious risk of device recoil into coronary arteries can be catastrophic.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary fistulas, abnormal connections between coronary arteries and other heart chambers or vessels, can be congenital or acquired.
- Traditional surgical repair of coronary fistulas is associated with significant morbidity and mortality.
- Percutaneous transcatheter closure offers a less invasive alternative for managing coronary fistulas.
Observation:
- This study evaluated transcatheter intervention for arteriosystemic and arteriovenous coronary fistulas in seven patients with ten fistulas.
- Seven fistulas were successfully closed using embolic coils (6) or a covered stent (1).
Findings:
- Percutaneous transcatheter closure of coronary fistulas demonstrated simplicity, ease of use, and effectiveness in this patient cohort.
- The primary complication was a fatal event due to device recoil into a major epicardial coronary artery.
Implications:
- Transcatheter closure is a viable and effective treatment for coronary fistulas.
- Careful device selection and deployment are crucial to mitigate the risk of catastrophic recoil into coronary arteries.
Abstract:
This study details different methodologies of percutaneous closure of arteriosystemic and arteriovenous coronary fistula. Seven patients underwent transcatheter intervention of 10 fistulas, with 7 fistulas successfully closed: 6 with embolic coil devices and 1 with a covered stent obstructing the fistula ostium. The major complication encountered was one death as a result of device recoil into a major epicardial vessel. Percutaneous transcatheter closure of coronary fistulas appears to be simple, facile, and effective. However, device recoil into an undesired arterial segment, while irritating in a noncoronary arterial tree, may be catastrophic when occurring in an epicardial coronary artery.