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Embolisation of a complex coronary arteriovenous fistula in a 6 year old child: the need for specialised embolisation
Insights
Transcatheter embolisation successfully closed a large coronary arteriovenous fistula in a child. This minimally invasive procedure involved occluding feeding arteries to stop abnormal blood flow.
Area of Science:
- Cardiology
- Interventional Radiology
- Pediatric Cardiology
Background:
- Large arteriovenous fistulas between the left coronary artery and right ventricle are rare and can cause significant hemodynamic issues.
- Surgical intervention for such conditions in children carries substantial risks.
Observation:
- A six-year-old child presented with a large, hemodynamically significant arteriovenous fistula between the left coronary artery and right ventricle.
- Initial embolisation targeted a septal branch of the left anterior descending coronary artery with a detachable balloon and coil.
Findings:
- The initial embolisation reduced fistula flow but did not achieve complete occlusion.
- A previously undetected small diagonal branch was identified as a collateral supply.
- Successful complete fistula occlusion was achieved by embolising this secondary branch using a coaxial catheter technique and a microcoil.
Implications:
- Transcatheter embolisation is a viable and effective treatment for complex coronary arteriovenous fistulas in pediatric patients.
- This case highlights the importance of meticulous imaging to identify all feeding vessels during embolisation procedures.
- Minimally invasive techniques offer a safer alternative to surgery for these rare congenital heart anomalies.
Abstract:
Transcatheter embolisation was performed in a six year old child with a large haemodynamically significant arteriovenous fistula between the left coronary artery and right ventricle. The fistula seemed to fill via a single large septal branch of the left anterior descending coronary artery. This was occluded distally with a detachable balloon backed up by a proximal coil. After this the flow through the fistula was considerably reduced but it still filled via a small diagonal branch that had not been noted previously. This branch was subsequently occluded in its most distal part by a coaxial catheter technique and a single microcoil. Complete occlusion of the fistula was produced and there were no complications.