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Transcatheter closure of coronary artery fistulas
1Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
Insights
Transcatheter closure effectively treated coronary artery fistulas using coils or umbrella devices. This minimally invasive approach achieved complete occlusion in all nine patients, with minor complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a cardiac chamber or great vessel.
- While often congenital, CAFs can be acquired and may lead to significant cardiovascular complications.
Purpose of the Study:
- To evaluate the efficacy and safety of transcatheter closure for various types of coronary artery fistulas.
- To assess the performance of different occluding devices in achieving fistula closure.
Main Methods:
- Transcatheter closure was performed in nine patients with CAFs originating from different coronary arteries.
- Occlusion was achieved using Gianturco coils, double-umbrella devices, or a combination thereof.
- Patients with multiple CAFs were excluded from attempted occlusion.
Main Results:
- Complete occlusion of all treated coronary artery fistulas was achieved in all nine patients.
- The primary closure methods included Gianturco coils (6 patients), double-umbrella devices (2 patients), and a combined approach (1 patient).
- Complications were minimal, including two coil migrations (one retrieved) and transient junctional tachycardia in one patient.
Conclusions:
- Transcatheter closure is a safe and effective treatment for coronary artery fistulas.
- Coil and umbrella devices provide successful occlusion with a low complication rate.
- This minimally invasive technique offers a viable alternative to surgical intervention for selected CAF patients.
Abstract:
Transcatheter closure of a coronary artery fistula was undertaken in nine patients. There were three fistulas from the left circumflex coronary artery to the coronary sinus, three from the left anterior descending coronary artery to the right ventricular apex, two from the right coronary artery to the superior vena cava/right atrial junction and one fistula from the left circumflex artery to the pulmonary artery. The fistula was closed with Gianturco coils in six patients, a double-umbrella device in two and a combination of an umbrella and coils in one patient. All fistulas are completely occluded. Complications consisted of migration of two coils, one of which was retrieved, and a transient junctional tachycardia in one patient. In an additional three patients with multiple coronary artery fistulas, transcatheter occlusion was not attempted.