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Transcatheter closure of multiple coronary artery fistulas: a coronary computed tomography angiography-based anatomic

Peijian Wei1, Yihang Li1, Fengwen Zhang1

  • 1Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China.

Revista Espanola De Cardiologia (English Ed.)
|July 15, 2024
PubMed

Insights

Multiple coronary artery fistulas (MCAFs) are common and have distinct anatomical features. Transcatheter closure of MCAFs has a significantly higher failure rate compared to single coronary artery fistulas.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Congenital Heart Disease

Background:

  • Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a cardiac chamber or great vessel.
  • Multiple coronary artery fistulas (MCAFs) represent a complex subset of CAFs with unique anatomical characteristics.

Purpose of the Study:

  • To retrospectively analyze the anatomical features and classification of MCAFs.
  • To compare the outcomes of transcatheter closure between MCAFs and single coronary artery fistulas.

Main Methods:

  • Retrospective review of 146 patients undergoing attempted transcatheter closure of CAFs from 2010 to 2023.
  • Categorization into single fistula and MCAF groups.
  • Comparison of anatomical characteristics and closure outcomes.

Main Results:

  • MCAFs accounted for 32.19% of CAFs, with types I, II, and III comprising 40.43%, 42.55%, and 17.02% respectively.
  • MCAFs predominantly originated from the right coronary artery and left anterior descending artery, draining into the pulmonary artery, often with a plexus-like morphology.
  • Transcatheter closure success rate was significantly lower for MCAFs (64.29%) compared to single fistulas (84.34%), with MCAFs having 2.64 times higher risk of failure.

Conclusions:

  • MCAFs are a common and distinct entity within CAFs, classifiable by origin and termination.
  • Transcatheter closure of MCAFs presents a significantly higher risk of failure than that of single fistulas.
Abstract

Keywords:
AnatomyAnatomíaCierre percutáneoCongenital coronary artery fistulaFístula coronaria congénitaFístula coronaria múltipleMultiple coronary artery fistulaTranscatheter closure

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