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[Coronary artery fistula--surgical or percutaneous embolization treatment?]
W Kienast1, K Emmrich, J Schultz
1Kardiologische Abteilung der Kinderklinik, Medizinischen Fakultät der Universität Rostock.
Insights
Congenital coronary artery fistulas in children, though rare, require timely intervention. Early diagnosis and treatment, including surgery or transcatheter embolization, significantly improve outcomes for these unusual vascular anomalies.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Congenital coronary artery fistulas (CCAFs) are rare anomalies where coronary arteries connect directly to heart chambers.
- Diagnosis and management strategies for CCAFs in pediatric patients are critical for preventing complications.
Observation:
- Three pediatric cases of left coronary artery to right atrium fistula were observed over two years.
- Two younger children required emergency surgery due to right atrial aneurysm obstructing the superior vena cava and an enlarged fistula.
- An older child with a ramus circumflexus fistula underwent successful percutaneous transcatheter coil embolization.
Findings:
- Two-dimensional echocardiography and color flow mapping are effective diagnostic tools for CCAFs.
- Coronary angiography is recommended for all diagnosed cases to fully delineate fistula anatomy.
- Transcatheter coil embolization offers a viable alternative to surgical closure in select pediatric CCAF cases.
Implications:
- Early intervention is crucial for congenital coronary artery fistulas in children.
- Prompt diagnosis and appropriate treatment can prevent severe complications like cardiac obstruction.
- Minimally invasive techniques like transcatheter embolization expand treatment options for pediatric CCAFs.
Abstract:
Three children aged 4 months, 2.7 and 7 years with the unusual fistula of the left coronary artery to the right atrium were observed over a 2-year period. The two younger children underwent emergency surgery although they showed no clinical symptoms. The reasons for surgical intervention were an aneurysm in the right atrium with obstruction of the vena cava superior and a considerably enlarged fistula, respectively. In the older child, we percutaneously embolized a terminate fistula of the ramus circumflexus with two platinum microcoils without complications. Two-dimensional-echocardiography and color flow mapping were used to confirm the diagnosis. After such diagnosis we recommend a coronary angiography in every case. The transcatheter-coil-embolization is an alternative method to surgical closure in selected cases. We recommend an early onset intervention in case of congenital coronary artery fistula.