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Published on: February 26, 2013
Transcatheter embolisation of coronary artery fistulae
R N Justo1, R E Slaughter, C M Whight
1The Queensland Centre for Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia. robert_justo@health.qld.gov.au
Insights
Transcatheter embolisation effectively treats coronary artery fistulae in children. This safe procedure achieved complete closure in most cases, with no significant complications, offering a viable therapeutic option.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulae in children often require intervention due to potential late morbidity.
- While many pediatric patients are asymptomatic, early treatment is crucial.
Purpose of the Study:
- To evaluate the outcomes of transcatheter embolisation for coronary artery fistulae in pediatric patients.
- Assessing the safety and efficacy of this minimally invasive approach.
Main Methods:
- Six children underwent transcatheter embolisation of coronary artery fistulae.
- Procedures involved microcoils and polyvinyl alcohol foam particles for embolisation.
- Catheter-based techniques were used to access and occlude the fistulae.
Main Results:
- Complete occlusion of fistulae was achieved in four out of six patients.
- Two patients had minor residual shunts post-procedure.
- No early or late cardiac complications were reported.
Conclusions:
- Transcatheter embolisation is a safe and effective treatment for coronary artery fistulae in children with appropriate anatomy.
- This minimally invasive technique offers a successful therapeutic strategy.
Background:
Most children with coronary artery fistulae are asymptomatic, but because of associated late morbidity, early intervention is usually indicated.
Aim:
To assess the outcome following transcatheter embolisation of coronary artery fistulae.
Patients And Methods:
Six children, with a median age of 9.5 years (range: 1.3-13.7 years), underwent transcatheter embolisation of coronary artery fistulae. Four patients had simple fistulae, which drained from the right coronary artery to the right ventricle (n = 2), the left coronary artery to the right ventricle (n = 1), or the left coronary artery to the coronary sinus (n = 1). Two patients had complex multiple fistulae arising from both coronary arteries, which communicated with either the right ventricle or the pulmonary arterial system.
Results:
A stable position with a 5-Fr coronary catheter was obtained proximally and a 3-Fr coaxial catheter was advanced through the coronary catheter to a distal position in the coronary artery fistulae. The number of embolisation microcoils used per procedure ranged from one to 12, and the coil diameter ranged from 3 mm. Polyvinyl alcohol foam embolisation particles (1000 microm) were used to embolise small fistulae to the pulmonary arterial tree. Complete occlusion was obtained in four patients, while two children were left with insignificant residual shunts. There were no early or late cardiac complications.
Conclusion:
Transcatheter embolisation of coronary artery fistulae is a safe and effective therapy in patients with suitable anatomy.
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