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Updated: Nov 20, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Mid-Term Follow-Up of Transcatheter Closure for Coronary Cameral Fistula in Pediatrics
Yi-Hua Wu1, Tse-Yi Li1, Ying-Jui Lin1
1Division of Cardiology, Department of Pediatrics.
Insights
Transcatheter closure of coronary cameral fistulas (CCFs) in children is safe and effective. Post-closure changes in coronary artery size may indicate prognosis for pediatric CCF patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coronary cameral fistula (CCF) is a rare anomaly connecting coronary arteries to heart chambers.
- CCFs can cause coronary steal phenomenon and cardiac overload in children.
- Understanding CCF characteristics and outcomes after treatment is crucial.
Purpose of the Study:
- To investigate clinical and cardiovascular features in pediatric patients with CCFs.
- To evaluate the outcomes of transcatheter closure for CCFs in children.
- To identify potential prognostic indicators after CCF treatment.
Main Methods:
- Retrospective review of pediatric patients diagnosed with CCFs via echocardiography (1998-2019).
- Data collection included patient demographics, echocardiograms, and catheterization/intervention details.
- Analysis of clinical and cardiovascular changes before and after transcatheter occlusion.
Main Results:
- Twelve pediatric patients with CCFs were analyzed; median age at diagnosis was 0.2 years.
- Transcatheter closure was performed using coils or vascular plugs in 11 of 12 patients.
- Post-closure, conduit coronary arteries decreased in size, and ipsilateral branches increased, with one patient showing a pulmonary-to-systemic flow ratio increase.
Conclusions:
- Transcatheter occlusion is a safe and effective treatment for pediatric coronary cameral fistulas.
- CCF morphology exhibits variability in dilation, tortuosity, and aneurysm formation.
- Changes in coronary artery dimensions after occlusion may serve as prognostic markers.
Background:
Coronary cameral fistula (CCF), a rare abnormal coronary communication to cardiac chambers, may lead to coronary steal phenomenon and increase cardiac overload. We investigated the clinical and cardiovascular characteristics in children before and after transcatheter closure.
Methods:
We retrospectively reviewed pediatric patients with CCFs diagnosed by echocardiography in a tertiary medical center between 1998 and 2019. Basic information, echocardiogram, catheterization and interventional procedures were obtained from medical charts.
Results:
A total of 12 pediatric subjects were included. The median ages at diagnosis and catheterization were 0.2 and 2.8 years, respectively. All CCFs were unilateral and single with varying degrees of coronary artery dilatation and aneurysm formation and diagnosed by echocardiography. The median follow-up periods before and after catheterization were 2.5 and 7.3 years, respectively. Seven of the CCFs originated from the left side. The drainage sites were all right hearts. Before catheterization, the median size of the proximal end of the fistula was 3.1 mm, concomitant with enlargement of conduit coronary arteries. Eleven of the 12 patients underwent transcatheter closure using coils in six and vascular plugs in five. Only one patient had a significant increase in pulmonary-to-systemic flow ratio. The size of conduit coronary artery gradually decreased and the size of ipsilateral coronary branch increased after closure.
Conclusions:
Transcatheter occlusion for CCFs in children is safe and effective. The morphology of CCFs varies with the degrees of dilation, tortuosity, and aneurysmal formation. After occlusion, alterations in the size of coronary arteries may be a prognostic indicator.
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