Hybrid approach to closure of an acquired coronary-cameral fistula
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Imthiaz Manoly1, Vaikom S Mahadevan1, J Andreas Hoschtitzky1
1Adult Congenital Heart Disease Unit, Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
Insights
A complex coronary-cameral fistula in a patient with tetralogy of Fallot was successfully closed using a hybrid approach. This method combined imaging to locate the fistula with surgical intervention, offering a potentially safer alternative.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Coronary-cameral fistula (CCF) is an abnormal connection between a coronary artery and a heart chamber.
- Significant CCFs often necessitate closure to prevent complications such as heart failure or arrhythmias.
- Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical correction.
Observation:
- A 19-year-old male with TOF presented with a complex CCF.
- The complexity of the CCF precluded standard percutaneous closure methods.
- A hybrid approach was utilized to manage the CCF in conjunction with TOF repair.
Findings:
- The hybrid approach facilitated precise localization of the complex CCF.
- Surgical closure of the CCF was achieved efficiently following the hybrid localization.
- This strategy successfully addressed the CCF in the context of TOF.
Implications:
- A hybrid approach can simplify the management of complex CCFs, especially when associated with other cardiac anomalies.
- This technique may reduce operative time and potentially lower perioperative risks in complex cardiac surgeries.
- The findings suggest a valuable alternative for challenging CCF cases requiring surgical intervention.
Abstract:
Coronary-cameral fistula is an abnormal fistulous communication between a coronary artery and a cardiac chamber. Significant fistulae require closure either percutaneously or surgically to avoid any complications. We describe the case of a 19-year-old male patient with tetralogy of Fallot, who presented with a complex coronary-cameral fistula, which precluded percutaneous occlusion. By means of a hybrid approach, the fistula was easily located and closed surgically. Where surgical correction of such fistulae is warranted in the setting of other cardiac defects, a hybrid approach to isolate the fistula followed by surgical intervention will reduce operative time, thereby potentially lowering perioperative complications.
