Long-term follow-up of transcatheter closure of congenital coronary cameral fistulas in infants and children: experience from a single center

Abstract

Abstract Background Transcatheter closure(TCC) has been considered as an effective treatment for anatomically suitable coronary cameral fistulas(CCF).However, limited data are available regarding long-term outcomes TCC of CCF in the pediatric population. Purpose The long-term efficacy and safety of TCC for the management of CCF was investigated in pediatric patients. Methods All pediatric patients(＜18 years old) diagnosed with CCF who were scheduled to undergo TCC between 2005 and 2019 in our center were retrospectively enrolled.CCF anatomic characteristics, procedural techniques, and follow-up outcomes were reviewed. Results 81 patients(42 males, median age 3.24 years) with CCF underwent diagnostic coronary angiography, and 66 patients(median age 3.93 years,median weight 15Kg) underwent attempted TCC of CCF. Immediate successful device implantation was achieved in 62 patients, and immediate complete occlusion was achieved in 44 patients(44/62, 71.0%). The closure procedure was waived in 2 patients because of challenging anatomic structures, and a total of 6 periprocedural complications occurred in 5 patients, including acute myocardial infarction(n=3),procedural-related death(n=1), device embolization(n=1), and rupture of tricuspid chordae tendineae(n=1). The acute procedural success rate was 89.4%(59/66), and the acute complication rate was 9.1%(6/66). Follow-up data were collected for 58 (93.5%) out of 62 patients at a median of 9.3 years(range, 3.0-15.7 years). Among them, 10 adverse events occurred in 9 patients, including 5 follow-up complications(1 aortic valve perforation, 1 coronary thrombosis, 1 progressive aneurysmal dilation after reintervention, 2 new-onset tricuspid prolapse with significant regurgitation), and 5 closure failure with large residual shunts. The long-term adverse event rate was 17.2% (10/58). The angiographic features associated with both acute and long-term adverse were large CCF(P=0.005), and giant coronary artery aneurysm(CAA) (P=0.029). Conclusions TCC of CCF in infants and children appears to be safe and effective. Patients with large CCF and giant CAA may be at higher risk for both acute and long-term adverse events.Patient flow chartClosure strategies of TCC of CCF