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Published on: December 23, 2022
Transcatheter closure of coronary artery fistula in children
Liang Xu1, Zhong-Ying Xu, Shi-Liang Jiang
1Department of Radiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Cardiovascular Institute & Fu Wai Hospital, Beijing 100037, China.
Insights
Transcatheter closure using coils or occluders effectively treats coronary artery fistulas (CAF) in children. This minimally invasive approach offers a safe and successful alternative to surgery for congenital CAF.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Transcatheter closure is a viable alternative to surgery for coronary artery fistulas (CAF).
- This study details experiences with transcatheter closure in 10 pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of transcatheter closure for congenital coronary artery fistulas in children.
- To report procedural outcomes and short-term follow-up results.
Main Methods:
- Ten children (3-10 years old) with congenital CAF underwent percutaneous transcatheter closure.
- Fistulas originated from the right coronary artery (7), left anterior descending (2), and left circumflex (1) arteries.
- Closure devices included Cook coils (4) and Amplatzer PDA occluders (6).
Main Results:
- Technical success was achieved in all 10 patients.
- Complete occlusion was observed in 90% of patients, with minimal residual flow in 10%.
- Short-term follow-up showed complete shunt abolition with no recurrence.
Conclusions:
- Transcatheter therapy with Cook coils or Amplatzer PDA occluders is safe and effective for CAF occlusion.
- Midterm outcomes for interventional treatment of pediatric CAF are satisfactory.
Background:
Transcatheter closure of coronary artery fistula (CAF) has emerged as a successful alternative to surgery. We described our experiences in 10 children patients who were accepted for transcatheter closure of CAF.
Methods:
Ten children were 3 - 10 years old (seven males) with CAF who underwent percutaneous transcatheter closure between October 1995 and April 2008. Sites of origin of these fistulas were: right coronary artery in seven, left anterior descending coronary artery in two, and left circumflex coronary artery in one patient. Drainage sites of these fistulas were: right atrium in seven, right ventricle in two and left ventricle in one patient. All of these fistulas were congenital and had only one orificium fistula.
Results:
A Cook coil was used in four patients and an Amplatzer patent ductus arteriosus (PDA) occluder was used in six patients. Checking the angiogram after the procedure revealed complete occlusion in nine patients (90%) and minimal residual flow in one (10%) patient. Technical success was achieved in all patients. Follow-up studies at short term showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt.
Conclusions:
Transcatheter therapy using either Cook coil or Amplatzer PDA occluder is suggested to be a safe and effective method of occlusion. The midterm outcome of the intervention for CAF is satisfactory.
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