Abstract
BackgroundCoronary artery fistula (CAF) is a rare congenital anomaly with a challenging scenario in children. This study reports our experience in transcatheter closure of CAF with Nit-Occlude PDA coil and midterm clinical and imaging follow-up.MethodsTwelve children with congenital CAF between 2009 and 2019, mean age 2.05 ± 2.05 years (4 days to 7.2 years), mean weight 8.8 ± 4.83 (2.8–17 kg), who underwent transcatheter closure with PFM coil at the Namazi hospital, Shiraz, Iran, were reported. Echocardiography and electrocardiogram were done before and after the procedure (early, 3, and 6 months after), and Multi-slice computerized tomography or conventional coronary angiography was performed at least one year after closure.ResultsIn a median follow-up of 5.5 years (range 13 months to 8 years), retrogradely closed fistula had no residual, and the fistula tract was wholly occluded, but in most anterogradely closed fistula, had a small residual, which made the fistula tract open and need additional coil closure.ConclusionsTranscatheter closure of CAF with PFM coil is feasible and effective with low mortality and morbidity, although antegrade closure with this device may be accompanied by residual shunt and need for multiple coil insertion.
Highlights
Coronary artery fistula (CAF) is a rare congenital anomaly that is defined as a connection between coronary arteries, left or right coronary artery (LCA, RCA), and a cardiac chamber or great vessels such as the aorta or the pulmonary artery [1]
According to some indications such as dilation of heart chambers during serial follow-up of patients with CAF, appropriate time and modality of treatment should be chosen by cardiologists such as dilation of heart
With the improvement of transthoracic echocardiography, even small CAF without a cardiac murmur [1, 5] or any sign or symptoms can be detected and diagnostic cardiac catheterization for small children is available for confirmation of diagnosis
Summary
Coronary artery fistula (CAF) is a rare congenital anomaly that is defined as a connection between coronary arteries, left or right coronary artery (LCA, RCA), and a cardiac chamber or great vessels such as the aorta or the pulmonary artery [1].According to angiographic evaluation and reports of the adult population, the incidence of CAF is about 0.13– 0.6% [1], but the incidence in the pediatric population is not precisely known due to the silent presence of this congenital heart disease.In rare cases, CAF’s spontaneous closure has been reported [1, 2], and the best time of closure and the best equipment for management CAF in children is challenging. According to some indications such as dilation of heart chambers during serial follow-up of patients with CAF, appropriate time and modality of treatment should be chosen by cardiologists such as dilation of heart. The best time of treatment is another challenge, and according to some longitudinal studies of children with CAF, even in small and asymptomatic CAF, severe and lethal hemodynamic, thrombotic or ischemic complications were reported in adulthood. According to these complications and difficulty of CAF treatment in adulthood, due to the tortuosity of CAF courses, new studies recommended earlier treatment of CAF in childhood [1, 4, 6]. This study reports our experience in transcatheter closure of CAF with Nit-Occlude PDA coil and midterm clinical and imaging follow-up
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