[Percutaneous closure of congenital and iatrogenic coronary arterial fistulas]
A Fontanelli1, D Gasparini, G Bernardi
1Laboratorio di Emodinamica Interventistica, Istituto di Cardiologia, Udine.
Insights
Percutaneous occlusion is now the primary treatment for coronary arteriovenous fistulas (CAF), offering a safe and effective alternative to surgery. Different devices can be tailored to individual patient anatomy and fistula characteristics.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary arteriovenous fistulas (CAF) are the most common hemodynamically significant congenital coronary anomalies.
- Historically, surgical intervention has been the sole therapeutic approach for CAF.
- This study explores the efficacy of percutaneous occlusion as an alternative treatment modality.
Observation:
- Three distinct cases of CAF (congenital and iatrogenic) were treated using percutaneous occlusion.
- Case 1 involved a 20-year-old asymptomatic male with a right coronary artery to right ventricle fistula treated with a detachable latex balloon.
- Case 2 presented a 63-year-old female with exertional angina and multiple fistulas from the circumflex and LAD arteries to the pulmonary artery, treated with coils.
- Case 3 described a 62-year-old male, post-cardiac transplant, with a developing fistula from the LAD to the right ventricle, managed with coils.
Findings:
- All three percutaneous occlusion procedures demonstrated favorable outcomes.
- No acute or late complications were observed in any of the cases.
- Six-month clinical and angiographic follow-up confirmed satisfactory results, including fistula closure and improved coronary flow.
Implications:
- Percutaneous occlusion should be considered the first-line therapy for coronary arteriovenous fistulas.
- The selection of appropriate devices allows for tailored treatment based on specific anatomical and functional characteristics of each fistula.
- This minimally invasive approach offers a safe and effective alternative to traditional surgical management, improving patient outcomes.
Abstract:
Coronary arteriovenous fistulas (CAF) are the most common hemodinamically significant congenital coronary anomalies. Surgery has been the only therapeutic option for ages. We describe three cases of percutaneous occlusion of CAF, congenital and iatrogenic, that we treated with different devices, to fit their different anatomic and functional characteristics. Case 1). Male patient (pt) 20 years old, asymptomatic, affected with CAF between the right coronary artery and the right ventricle, with aneurysmatic vessel dilatation and occlusion of the posterolateral branches. CAF has been occluded with a detachable, valvulated latex balloon, wedged into the proximal neck of the aneurysm. Case 2). Female pt 63 years old, who was symptomatic for exertion angina, affected with multiple CAF which originated from proximal and distal circumflex artery, proximal left anterior descending artery (LAD), all of which flowed into the left inferior lobar pulmonary artery. The fistulas have been occluded with steel and tungsten coils. Case 3). Male pt 62 years old, who underwent orthotopic cardiac transplantation in 1990 for dilated cardiomyopathy. Coronary angiogram at one year was normal, but subsequently a multilocular CAF between LAD in the middle portion and the right ventricle became evident. During angiographic follow-up an increase of the size of the fistula was observed, together with a reduction of that of distal LAD. For this reason a percutaneous occlusion with multiple tungsten coil has been performed. The three procedures have had a favorable outcome and we did not observe any acute or late complications; clinical and angiographic follow-up confirmed this satisfactory results at six months. Based on the data of the literature and on this experience, we conclude that percutaneous occlusion is the first line therapy of CAF and that the different devices can be tailored to meet different anatomic and functional characteristics.
