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[Transcatheter closure in various types of congenital coronary artery fistula: a follow-up study]
Yun-Bin Xiao1, Zhi Chen, Xi-Yong Huang
1Department of Cardiology, Hunan Provincial Children's Hospital, Changsha 410007, China. eychenzhi@163.com.
Insights
Transcatheter closure (TCC) is a safe and effective treatment for coronary artery fistulas (CAF) in children. Postoperative aspirin use may help prevent thrombosis, but further research is needed.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Context:
- Coronary artery fistulas (CAF) are abnormal connections between a coronary artery and a cardiac chamber or great vessel.
- Transcatheter closure (TCC) offers a minimally invasive alternative to surgical repair for CAF.
- Evaluating TCC outcomes in pediatric populations is crucial for guiding clinical practice.
Purpose:
- To assess the short- and medium-term effectiveness and safety of TCC for pediatric coronary artery fistulas (CAF).
- To analyze anti-coagulation strategies and complication rates associated with TCC in children.
- To determine the impact of TCC on cardiac function and dimensions.
Summary:
- This retrospective study reviewed 12 children (age 1-158 months) who underwent successful TCC for CAF.
- Postoperative follow-up averaged 3.5 years, with most patients receiving aspirin for 6-18 months.
- No coronary thrombosis or procedural complications occurred; significant improvements were observed in left ventricular ejection fraction, cardiothoracic ratio, pulmonary artery pressure, and coronary artery lesion size.
Impact:
- Transcatheter closure (TCC) is a feasible and safe therapeutic option for various types of coronary artery fistulas (CAF) in pediatric patients.
- Aspirin anti-coagulation may mitigate short- to medium-term thrombotic risks following TCC.
- Further long-term follow-up studies are warranted to fully establish the safety and optimal anti-coagulation regimen for TCC in children with CAF.
Objective:
To evaluate the short- and medium-term efficacy, complications, and anti-coagulation therapies related to transcatheter closure (TCC) of coronary artery fistula (CAF) in children.
Methods:
We conducted a retrospective review of the medical records of 12 children with CAF who underwent TCC between January 2006 and January 2014, focusing on details such as preoperative, radiographic, and postoperative follow-up data, to record closure methods for CAF, anti-coagulation therapies, postoperative complications, and results of auxiliary examinations.
Results:
Among the 12 cases who underwent successful TCC and whose age was 1-158 months, four patients had proximal/medium-sized CAF, five had proximal/large CAF, and three had distal/medium-sized CAF. The mean period of postoperative follow-up was 3.5±2.4 years. Eleven patients took aspirin for 6 months post closure, and one took it for 18 months. Neither coronary thrombosis nor interventional complications were found. Left ventricular ejection fraction, cardiothoracic ratio, pulmonary artery pressure, and the diameters of coronary artery lesions decreased post TCC.
Conclusions:
TCC is feasible and safe in proximal and distal/medium-sized CAF patients. Postoperative anti-coagulation with aspirin may prevent short- and medium-term thrombosis, but treatment course and safety need to be investigated by further follow-ups.
