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Catheter closure of coronary artery fistulas
1Department of Congenital Heart Disease, Guy's Hospital, St. Thomas Street, London SE1 9RT, United Kingdom. Shakeel.Qureshi@gstt.sthames.nhs.uk
Insights
Catheter closure effectively treated coronary artery fistulas in 97% of patients using coils, particularly controlled-release coils. This minimally invasive technique offers a viable alternative to surgery for these rare vascular anomalies.
Area of Science:
- Cardiology
- Interventional Radiology
Background:
- Coronary artery fistulas are uncommon congenital or acquired heart conditions with diverse presentations.
- Surgical intervention has been the traditional treatment for coronary artery fistulas.
Purpose of the Study:
- To evaluate the efficacy and safety of catheter-based closure for coronary artery fistulas.
- To assess the role of various occlusion devices, especially coils, in treating these fistulas.
Main Methods:
- Retrospective analysis of 40 patients undergoing catheter closure of coronary artery fistulas.
- Utilized devices included detachable balloons, stainless steel coils, controlled-release coils, and Amplatzer PDA plugs.
- Focused on occlusion rates, procedural success, and complications.
Main Results:
- Successful fistula occlusion was achieved in 39 (97%) of 40 patients.
- Controlled-release coils were the most frequently used and effective devices.
- The primary complication was device embolization (17%), with coils being retrieved in most cases.
Conclusions:
- Catheter closure, particularly with controlled-release coils, is a safe and effective alternative to surgery for coronary artery fistulas.
- The procedure demonstrated high success rates and manageable complications.
Abstract:
Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled-release coils, controlled-release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled-release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4-month-old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled-release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment.