OP-036 TRANSCATHETER CLOSURE OF CORONARY ARTERY FISTULAS

Abstract

Objective: Coronary artery fistulas (CAF) are rare congenital or acquired malformations in which a direct vascular connection from a coronary artery to a cardiac chamber or a great vessel, bypassing the myocardial capillary network exists. Large fistulas may cause heart failure, myocardial ischemia, arrhythmias, endocarditis, potential aneurismal dilatation and rupture; and require closure, if symptomatic, upon recognition. METHODS and Results: Patients evaluated in our clinic with murmur, heart failure, history of infective endocarditis or suspected cardiac anomaly who were diagnosed with CAVF and cardiac catheterization was performed are included in this study. Between 2003 and 2009, 12 patients aged between 3 days and 204 months (median 42 months) were diagnosed with coronary artery fistulas and transcatheter closure of CAVF was accomplished in nine patients, whereas it was not possible to close the fistula in three patients. In the nine patients that TCC could be achieved, the fistula originated from the left coronary artery in six patients and from the right coronary artery in three; and ended in right side of the heart in seven and left side in two. A narrowing in the distal segment of the fistula was observed in almost all of the patients, and the diameter of this narrow segment was between 1-5 millimeters. The fistula was closed retrogradely in seven and anterogradely in two. Multiple microcoils, vascular plugs, PFM coils, fibrin glue and ADO II were used during the procedure. Control angiography was performed in eight patients. Seven patients had complete occlusion; one had further aneurismatic dilatation of left coronary artery and a residual shunt, and was referred to surgery. Patients were followed up for 13 -48 months (median 35 months) during which time no device related complication was observed and patients presented with heart failure showed significant improvement. Conclusions: Coronary artery fistulas can be safely and effectively closed using transcather techniques. Anatomical variations and different sizes of coronary artery fistulas necessitates availability of different sizes and types of devices at the time of catheterization for successful closure. Patients need to be closely followed up for complication such as residual shunts, new fistula formation and coronary artery stenosis.