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Percutaneous treatment of congenital coronary arteriovenous fistulas
Sivadasanpillai Harikrishnan1, Francis Bimal, Valaparambil Ajithkumar
1Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. drharikrishnan@hotmail.com
Insights
Percutaneous closure is a safe and effective treatment for congenital coronary arteriovenous fistulas (CAVF). This minimally invasive approach offers high success rates and low morbidity for patients with these rare heart conditions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Congenital coronary arteriovenous fistulas (CAVF) are rare but can cause significant hemodynamic disturbances.
- Intervention is often necessary to manage these lesions.
Observation:
- Six patients (ages 4-49) with CAVF underwent percutaneous transcatheter occlusion.
- Fistulas originated from various coronary arteries and drained into different heart chambers.
- Both Cook™ coils and nitinol ductal occluders (NDOs) were utilized for closure.
Findings:
- Complete fistula occlusion was achieved in all patients.
- One patient experienced coil migration requiring NDO closure; another had a myocardial infarction post-procedure.
- Mean follow-up of 39.6 months showed all patients were asymptomatic with no residual fistulae on echo-Doppler.
Implications:
- Percutaneous closure is a highly successful and safe treatment modality for CAVF.
- Minimally invasive techniques offer excellent long-term outcomes for patients with congenital coronary arteriovenous fistulas.
Background:
Congenital coronary arteriovenous fistulas (CAVF), although rare, can present as significant hemodynamic lesions necessitating intervention.
Methods And Results:
Six patients (two males) with congenital coronary arteriovenous fistulas (CAVF) underwent percutaneous transcatheter occlusion. The ages ranged from 4 years to 49 years (mean 20.1 years). The fistulas had their origins from the right coronary artery (two), the left anterior descending coronary artery (two), and the left circumflex coronary artery (two). One of the fistulas drained to the right ventricle, four drained to the right atrium, and the remaining one to the left ventricle (LV). The fistulas were closed using the arterial approach with Cook™ coils in two patients and with nitinol ductal occluders (NDOs) using the venous approach in four patients. One patient developed dissection of the wall of the fistula during attempted closure and had spontaneous occlusion of the fistula. Complete occlusion of the fistulas were achieved in all patients. Complications consisted of migration and embolization of the coils in one patient (later closed successfully with NDO) and myocardial infarction occurring two weeks following successful closure in another patient. At mean follow-up of 39.6 +/- 22.9 months, all patients were asymptomatic and echo-Doppler evaluation revealed no residual fistulae.
Conclusions:
CAVF are very well amenable to percutaneous closure with acceptable morbidity and high success rates.
