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Progressive aneurysmal dilation of coronary arterial fistula after transcatheter closure: successfully treated by a

Worakan Promphan1, Pimpak Prachasilchai1, Shakeel A Qureshi2

  • 11Pediatric Cardiology Unit,Queen Sirikit National Institute of Child Health (QSNICH),College of Medicine,Rangsit University,Bangkok,Thailand.

Cardiology in the Young
|July 31, 2014
PubMed

Insights

A large coronary artery fistula in a child was treated, but the aneurysm later compressed the heart. Successful occlusion of the aneurysm prevented further cardiac complications.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Interventional Cardiology

Background:

  • Coronary artery fistulas (CAFs) are rare congenital or acquired abnormal connections between a coronary artery and a heart chamber or vessel.
  • Large CAFs, particularly those involving the right coronary artery, can lead to significant complications such as aneurysm formation, heart failure, and myocardial ischemia.

Observation:

  • A 6-year-old boy presented with a massive right coronary artery (RCA) to right ventricle (RV) fistula.
  • Previous treatment involved device closure at the RV exit point.
  • Three years post-procedure, the RCA aneurysm showed progressive dilation, causing compression of the RV.

Findings:

  • The dilated RCA aneurysm posed a risk of further complications, including rupture or hemodynamic compromise.
  • A vascular plug was successfully deployed to occlude the proximal portion of the aneurysm.
  • This intervention effectively addressed the mass effect and potential risks associated with the aneurysm.

Implications:

  • Vascular plug occlusion offers a viable endovascular solution for managing large, complex coronary artery aneurysms causing mass effect.
  • This case highlights the importance of long-term surveillance after initial treatment of coronary artery fistulas.
  • Timely intervention can prevent severe cardiovascular events in pediatric patients with coronary artery anomalies.

Keywords:
treatment

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