921-71 Transcatheter Coil Embolization of Congenital Coronary Artery Fistulae

Abstract

We describe our experience with nonsurgical closure of coronary artery fistulae (CAF) using a transcatheter approach and Gianturco coils. Since 7/92 6 patients (pts) age 9 to 22 years (mean = 14.5) were referred for evaluation and treatment of CAF. Two were symptomatic with chest pain and a third had dyspnea on exertion. Catheterization was performed from the femoral region using IV sedation in 5, and general anesthesia in 1. Selective coronary angiograms were performed in all pts followed by hand or power injections within the fistulas themselves. Angled views were employed to detail fistula anatomy as well as to visualize coronary artery branches. Catheters were manipulated into each fistula from a retrograde aortic approach. Temporary balloon occlusion of the fistula with EKG monitoring was performed in 5. Coils were placed through an end hole catheter positioned distally within the fistula. Each pt had asingle fistula. Two CAF arose from the LAD: 1drained into the RV and 1 into the RA. One CAF arose from the circumflex artery and drained into the RV. Three CAF arose from the RCA: 2 drained into the RA and 1 into the RV. Temporary balloon occlusion in one pt resulted in significant ST segment changes and aided in the identification of the origin of the posterior descending artery adjacent to the fistulous connection to the RV. Coil embolization was not attempted in this pt. The remaining 5 pts underwent successful complete occlusion of the CAF using multiple (2 to 16) Gianturco coils. There were 2 coil embolizations to the pulmonary artery with successful retrieval of 1. At follow-up (1-15 months, mean = 11) all pts are asymptomatic with no clinical or echocardiographic evidence of recanalization or residual shunts. Transcatheter closure is the preferred method to safely and effectively close most CAF.