Closure of Isolated Congenital Coronary Artery Fistula: Long-Term Outcomes and Rate of Re-intervention.

Abstract

Long-term outcome after closure of isolated congenital coronary artery fistula (ICCAF) is poorly documented. To assess late outcome after ICCAF closure, a 1983-2013 retrospective study included all patients who attempted an ICCAF closure and whose follow-up was ≥1year. ICCAF was diagnosed in 23 patients [median age 6.9years (0.1-70.5years), 13 children]. ICCAF was symptomatic in 12 patients (52.2%). First intervention was either a transcatheter embolization (n=19 patients, 82.6%) or a surgical ligation (n=4 patients, 17.4%). After a follow-up of 9.0years (2.8-33.5), neither death nor late ischemic event occurred but one patient was transplanted, because of postoperative myocardial infarction. Late ICCAF recanalization occurred in eight patients, leading to successful embolization of the shunt in all patients after a delay of 9.8years (5.7-13.8years) from the first intervention. Re-intervention occurred later in children (p=0.0027), with a 50 and 37.5% freedom from re-intervention in adults compared to a 100 and 89.0% in children, respectively, at 1 and 6years of follow-up. At last follow-up, coronary artery diameter had decreased from a mean z score of 12.0±7.7 to a mean z score of 6.0±6.0 (p=0.002). Long-term outcome after ICCAF closure is excellent, with neither death nor late ischemic event, and a significant decrease in coronary artery diameter with time. Late follow-up is of paramount importance, as one-third of patients will require a re-intervention for late shunt recanalization.