Management Of Coronary Artery Fistula Research Articles

Three-Decade Experience With Management of Coronary Artery Fistulas in Children

BackgroundThe treatment approach for coronary artery fistulas (CAFs) is debatable, and long-term outcomes are unknown. MethodsThis was a retrospective institutional data review of children in whom echocardiographically suspected CAFs were confirmed during cardiac catheterisation from 1997 to 2023. Treatment approach and outcomes were assessed. ResultsWe identified 94 CAFs in 78 patients (42.3% male), median age 3.4 years (interquartile range [IQR] 0.9-6.6 y). Twenty-five patients (32%) had other congenital anomalies; 41 (78.8%) of the 52 patients with isolated CAFs were asymptomatic. The most common site of CAF origin and drainage was the left system (62.8%) and right cardiac cavities (80.8%). Overall median follow-up was 101 months (iqr 41-185 mo); 23 patients (29.5%) with 35 (37.2%) small or nonshunting CAFs had conservative management, and 20 (87%) of those 23 patients had an uneventful follow-up; 8 patients (10.2%) with 9 (9.6%) complex CAFs were directly sent for surgery; 1 patient had early surgical patch failure needing surgical reintervention; 47 patients (60.3%) had catheter closure of 50 (53.2%) medium- or large-sized CAFs with the use of coils (30%), vascular plugs (20%), nitinol duct occluders (40%), or material combination (10%). Six serious complications occurred. Two-thirds of patients with unsuccessful catheter procedures had subsequent surgeries. Two-thirds of patients with mild shunts had successful redo closures. One asymptomatic patient had recanalisation after 12 years and is under watchful observation. ConclusionsCAFs have various anatomies and clinical presentations. Transcatheter closure is effective in carefully selected patients but is not complication free. Surgery is a valuable up-front option in complex CAFs or bailout of unsuccessful transcatheter closures, although it is not frequently used.

Surgical Management of Coronary Artery Fistulas in Children.

This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1-25.6 years). The median age and body weight at repair were 3.1 years (range, 0-13.4 years) and 14.4 kg (range, 3.1-42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.

Retrospective review of M3C-Necker three-decade experience with transcatheter management of coronary artery fistulas in children

Retrospective review of M3C-Necker three-decade experience with transcatheter management of coronary artery fistulas in children

Retrospective review of M3C-Necker experience with transcatheter management of coronary artery fistulas

Retrospective review of M3C-Necker experience with transcatheter management of coronary artery fistulas

Coronary artery fistula with or without aneurysm: A large comparative study

BackgroundThe knowledge of coronary artery fistula (CAF) with coronary aneurysm mostly comes from case reports and is very limited. However, the management of CAF with and without aneurysm is different, more understanding of its clinical and imaging features is necessary. This is the first research focus on it through a large comparative study. PurposeTo investigate the differences in imaging and clinical features of CAF with and without aneurysms. MethodsWe reviewed 96,037 consecutive patients undergoing coronary computed tomography angiogram (CCTA) between 2016 and 2020 and total of 429 CAF adult patients were enrolled. Those patients were divided into the CAF with aneurysm group (321 cases, 74.83%) and CAF without aneurysm group (108 cases, 25.17%) according to whether complicated with coronary aneurysm. Clinical baseline data, electrocardiographic (ECG) characteristics, the presence or absence of coronary atherosclerosis, complication symptoms and fistulous origin, entry site, number and diameter were analyzed. Chi-square test, T-test, Mann-Whitney U tests, and logistic regression analysis were performed. ResultsMost of the clinical baseline data did not differ significantly between the two groups (P > 0.05). However, heart murmur, coronary atherosclerosis, infective endocarditis (IE), fistulous diameter and fistulous entry site were significantly different (P＜0.05). Further multivariate logistic regression analysis showed that large fistulous diameter and coronary-cardiac chamber arterial fistulas was dependent risk factors for CAF complicated with aneurysm. ConclusionCAF patients with aneurysm were more prone to develop heart murmur than those patients without aneurysm. Different from other sites of aneurysms, coronary atherosclerosis is more common in CAF without aneurysm. Larger fistulous diameter and coronary-cardiac chamber arterial fistula are dependent risk factors for CAF with aneurysms.

Coronary artery to pulmonary artery fistula: Catheter or scalpel? A case report.

IntroductionCoronary artery fistula (CAF) is an abnormal connection between coronary artery and a major vessel or cardiac chamber with left to right shunt having an incidence of 0.002 % in recent literature. Fistulous communication of coronary artery with pulmonary artery (PA) is a rare subtype and comprises of about 17 % of all the CAF cases.Case presentationWe report a case of a middle-aged gentleman, known case of asymptomatic CAF for the last 20 years. He presented to us with 6 months history of chest pain on exertion. On coronory angiogram he was diagnosed to have a preexisting CAF of proximal LAD to main PA and severe coronary artery disease in left anterior descending coronary artery (LAD). He was managed surgically and underwent ligation of the fistula along with coronary artery bypass grafting (CABG).Clinical discussionManagement of CAF is medical, percutaneous or open-heart surgery. Due to rarity of the disease no international guidelines exists and treatment is controversial. Complications of CAF include endocarditis, early atherosclerosis, rupture, hemopericardium, pulmonary hypertension and myocardial ischemia, hence early correction is warranted. Our case emphasizes on the natural course of this rare disease and how to change management plan accordingly in the better interest of patient.ConclusionOur case presents the natural course and management of a rare congenital cardiac disease. Surgery was chosen as an appropriate option due to CAD involving proximal LAD and concomitant coronary artery to PA fistula.

Management of coronary artery fistula with aneurysm.

Management of coronary artery fistula with aneurysm.

The clinical characteristics of coronary artery fistula anomalies in children and adults: A 24-year experience.

The aim of our work is to investigate the clinical characteristics of coronary artery fistula (CAF) anomalies in South Vietnam. This is a retrospective analysis of 119 patients with diagnosis of definite CAF between January 1992 and April 2016. The demographic, clinical, echocardiographic, and angiographic characteristics and management of CAF with short-term outcomes are described. The median age was 15 years (range, 1-79 years), with 49 male (41%) and 70 female (59%). There were 77 symptomatic patients (64.7%) and 91 patients (76.5%) who presented with a murmur. The electrocardiogram was abnormal in 45.4% and cardiac enlargement or increased pulmonary vasculature were seen in 76 patients (63.9%) on chest X-ray. The sensitivity of echocardiography for CAF diagnosis was 79%. The source of the fistula was most often from the RCA (54%), most commonly to right atrium (34.5%) or right ventricle (31.1%). In comparison with surgery, transcatheter closure had a shorter hospital length of stay (5.4 ± 3.8 days vs 12.6 ± 6.5 days, P=.02) and better postprocedural left ventricular ejection fraction (67.9 ± 8.1% vs 62.9 ± 6.0%, P = .03). The majority of fistula in this study originated from the RCA and terminated in the right atrium or the right ventricle. Transcatheter and surgical closure are both relatively safe and effective, with the potential for shortened length of hospital stay following transcatheter closure.

Right Coronary Artery-Superior Vena Cava Fistula Manifesting as NSTEMI: Case Report, Review of Imaging, and Summary of Guidelines.

Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society guidelines on the diagnosis and management of CAFs.

Is Fractional Flow Reserve Useful in Assessing Coronary Artery Fistula: A Case-Based Discussion and Review

We present two cases where fractional flow reserve (FFR) was utilised to guide management of coronary artery fistula (CAF), an approach advocated in recent case studies. CAF is a coronary anomaly that may present with a variety of syndromes though is frequently asymptomatic. When to exclude the fistula (surgically or percutaneously) is not always clear. A way to quantify if the fistula is physiologically meaningful would be advantageous. Our findings suggest FFR may only be assessing the concomitant epicardial coronary artery disease (CAD) rather than the degree of coronary steal and its routine use in this setting is not supported.

Transcatheter closure of right coronary artery fistula to the right ventricle

Coronary artery fistula (CAF) is an uncommon anomaly that is usually congenital but can be acquired. Although most patients are asymptomatic, some may present with congestive heart failure, infective endocarditis, myocardial ischemia or rupture. In the past, surgical ligation was the only option in the management of CAF, but since 1983, transcatheter closure of CAF has been increasing as an alternative to surgery. We report a 3-year-old boy, presented in Queen Alia Heart Institute, who underwent successful transcatheter closure of a large fistula communicating the distal part of the right coronary artery to the right ventricle. Our case differs from other CAFs in that the fistula was communicating the right coronary artery itself to the right ventricle.

A call to action for an underestimated entity: Our algorithm for diagnosis and management of coronary artery fistula

A call to action for an underestimated entity: Our algorithm for diagnosis and management of coronary artery fistula

Transcatheter closure of coronary arterial fistula: A single-center experience

Background: Transcatheter closure of coronary artery fistula has emerged as an alternative to surgery. The management of coronary artery fistula is complicated, and recommendations have been based on anecdotal cases or very small retrospective series. Objective: The objective of this study is to determine the safety, feasibility, and immediate and intermediate follow-up results of the transcatheter closure of coronary arterial fistula. Methods: We reviewed the records of all patients presenting with significant coronary arterial fistulae between January 2011 and May 2014. Those with additional complex cardiac disease requiring surgical management were excluded from the study. A total of nine patients aged 11 months to 58 years with congenital coronary arterial fistulae underwent percutaneous transcatheter closure using various devices between January 2011 and March 2014. The immediate closure results and clinical follow-up were reviewed using information from a database or telephone calls to the center. Results: Fistulae originated from the right coronary artery in 4 patients (44.4%), left circumflex coronary artery in 3 patients (33.3%), and left anterior descending coronary artery in 2 patients (22.2%). The drainage site was the right atrium in 5 patients (55.6%), right ventricle in 2 patients (22.2%), left ventricle in 1 patient (11.1%), and coronary sinus in 1 patient (11.1%). All of the patients (100%) underwent successful transcatheter closure using the various devices. Angiography after device deployment revealed complete occlusion in 7 patients (77.7%) and trivial to mild residual flow in 2 patients (22.2%). Two patients (22.2%) had transient ST-T wave changes after the procedure. The Amplatzer Vascular Plug II was used in four patients (44.4%), Amplatzer Duct Occluder II was used in three patients (33.3%), and Lifetech Duct Occluder was used in two patients (22.2%). The left ventricular end-diastolic volume decreased from a mean baseline value of 82.77 ± 4.55 ml/m 2 to 77.22 ± 3.49 ml/m 2 at 1 month after the procedure (P = 0.001) and had normalized in all of the patients at 2 months postprocedure. The cardiothoracic ratio decreased from a mean baseline value of 0.57 ± 0.035 to 0.53 ± 0.02 at the 1-month follow-up and further decreased to 0.50 ± 0.007 at 2 months (P Conclusion: Transcatheter closure of coronary arterial fistula is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients.

Transcatheter closure of coronary artery fistulas in infants and children: A French multicenter study.

The short-term efficacy and safety of transcatheter closure (TCC) for the management of coronary artery fistulas (CAFs) was investigated in pediatric patients. CAFS are rare with potentially severe complications and their management is still a matter of debate. Percutaneous closure appears to be the treatment of choice in anatomically suitable vessels but limited data are available in the pediatric population. This retrospective, observational, multicenter, national study included patients under 16 years of age who underwent TCC of a congenital CAF. Patients with additional congenital heart defect were excluded. 61 patients (36 girls, 25 boys) with a median age of 0.6 year [0-15.4] at diagnosis and 3.9 years [0-16] at procedure were included. The CAF was large in 48 patients (79%); it was distal in 23 (38%) and proximal in 22 (36%). Most patients (77%) were asymptomatic at diagnosis. Clinical signs of congestive heart failure were present in seven patients (11%). Perioperative complications included three cases of ST elevation myocardial infarction (exclusively during attempted closure of a distal CAF), three devices migrations, and one case of leg ischemia. One patient died after surgical closure of a large distal CAF that could not be closed by TCC. Follow-up data were collected for 43 patients (70%) for a median of 91 days [0-4,824]. The Kaplan-Meyer estimate for complete occlusion at 2 years was 73 ± 7.6%. TCC in the pediatric population appears to be effective and associated with few complications.

Aneurysmal Coronary Artery Fistulae: How Big is Big Enough?

Coronary artery fistula (CAF) is the most common congenital anomaly of coronary arteries. Management strategies for CAF causing symptoms and large shunting are well described. With growing use of noninvasive imaging modalities, the diagnosis of asymptomatic CAF has increased. This poses challenge on the management of CAF with high-risk features as therapeutic strategy of incidentally found CAF remains open to debate. The actual risk of complications in such cases is mere speculations based on small studies and need to be revisited. We describe the case of an asymptomatic 78-year-old woman with a large saccular coronary aneurysm associated with coronary artery to pulmonary artery fistula that was treated successfully using coils. We discuss the updated literature on the management of CAF as well.

Percutaneous Management of Coronary Artery Fistula in an Adult and Clinical Outcome

Coronary artery fistulae are rare congenital or acquired anomalies that usually communicate the coronary circulation with other vascular structures or cardiac chambers1-3. Although they might represent only an incidental finding on diagnostic angiography1, they can manifest clinically during childhood or adulthood as a shunt or coronary flow steal, motivating its closure via surgical or endovascular management4,5. In most cases, endovascular treatment has become the preferential option, not only due to the advantages of a percutaneous procedure, but also because of its confirmed efficacy and safety6,7.

Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula

ABSTRACT Coronary artery fistulas are rare but can have significant perioperative consequences. We describe the case of a 65- year-old man found to have a coronary artery fistula from the anterior right coronary artery to the coronary sinus. We discuss the unique advantages that transesophageal echocardiography offers in the monitoring and management of coronary artery fistulas. How to cite this article McHugh SM, Bader SO. Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula. J Perioper Echocardiogr 2013;1(1):21-23.

Asymptomatic Aorto-atrial Fistula Identified With Intraoperative Transesophageal Echocardiography

With great interest, we read the report of Takahashi et al1 titled “Intraoperative Imaging and Off-Pump Ligation of Coronary Artery Fistula.” The management of coronary artery fistula (CAF) is indeed somewhat controversial, especially in younger, asymptomatic patients. It generally is agreed that symptomatic lesions and larger fistulae with significant shunting should be treated. Surgical ligation2 generally is accepted as the treatment of choice in CAF.

Ten-year Angiographic Result of a Large Right Coronary Artery Fistula Treated Percutaneously: Many Questions Remain Unanswered

We describe an adult patient with right coronary artery to right atrium fistula, which was treated percutaneously 10 years earlier. His coronary angiogram done presently demonstrated no residual fistula, but there was persistence of aneurysmally dilated proximal right coronary artery segment that gave rise to many unanswered questions regarding management of coronary artery fistulas. We discuss the short- and long-term therapeutic dilemmas in the management of coronary artery fistula.

Coronary artery fistula: A case series with review of the literature

Coronary artery fistula (CAF) is an anomalous connection between a coronary artery and a major vessel or cardiac chamber. Most of the coronary fistulas are discovered incidentally during angiographic evaluation for coronary vascular disorder. The management of CAF is complicated and recommendations are based on anecdotal cases or very small retrospective series. We present three cases of CAF, two of which were symptomatic due to hemodynamically significant coronary steal phenomenon. They underwent successful transcatheter coil embolization, leading to resolution of their symptoms. Percutaneous closure offers a safe and effective way for the management of symptomatic patients. CAFs are rare cardiac anomalies but can give rise to a variety of symptoms because of their hemodynamic consequences or complications. They should be part of cardiac differential diagnosis particularly in patients without other risk factors. Correction of CAF is indicated if the patients are symptomatic or if other secondary complications develop.