This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Armsby, L. R. Articles by Lock, J. E. Search for Related Content PubMed PubMed Citation Articles by Armsby, L. R. Articles by Lock, J. E.

CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Management of coronary artery fistulae

Patient selection and results of transcatheter closure

Laurie R. Armsby, MD^*,*, John F. Keane, MD^*, Megan C. Sherwood, MBBS, FRACP^*, Joseph M. Forbess, MD, Stanton B. Perry, MD^* and James E. Lock, MD, FACC^*

^* Department of Cardiology, The Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Department of Cardiovascular Surgery, The Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received March 19, 2001; revised manuscript received October 10, 2001, accepted December 21, 2001.

^* Reprint requests and correspondence: Dr. Laurie R. Armsby, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115 USA.
armsby{at}cardio.tch.harvard.edu

OBJECTIVES: We report short-term findings in 33 patients after transcatheter closure (TCC) of coronary artery fistulae (CAF) and compare our results with those reported in the recent transcatheter and surgical literature.

BACKGROUND: Transcatheter closure of CAF has been advocated as a minimally invasive alternative to surgery.

METHODS: We reviewed all patients presenting with significant CAF between January 1988 and August 2000. Those with additional complex cardiac disease requiring surgical management were excluded.

RESULTS: Of 39 patients considered for TCC, occlusion devices were placed in 33 patients (85%) at 35 procedures and included coils in 28, umbrella devices in 6 and a Grifka vascular occlusion device in 1. Post-deployment angiograms demonstrated complete occlusion in 19, trace in 11, or small residual flow in 5. Follow-up echocardiograms (median, 2.8 years) in 27 patients showed no flow in 22 or small residual flow in 5. Of the 6 patients without follow-up imaging, immediate post-deployment angiograms showed complete occlusion in 5 or small residual flow in 1. Thus, complete occlusion was accomplished in 27 patients (82%). Early complications included transient ST-T wave changes in 5, transient arrhythmias in 4 and single instances of distal coronary artery spasm, fistula dissection and unretrieved coil embolization. There were no deaths or long-term morbidity. Device placement was not attempted in 6 patients (15%), because of multiple fistula drainage sites in 4, extreme vessel tortuosity in 1 and an intracardiac hemangioma in 1.

CONCLUSIONS: A comparison of our results with those in the recent transcatheter and surgical literature shows similar early effectiveness, morbidity and mortality. From data available, TCC of CAF is an acceptable alternative to surgery in most patients.

Abbreviations and Acronyms   TCC   CAF   coronary artery fistulae   Cx   circumflex   ECG   electrocardiogram   LAD   left anterior descending   LCA   left coronary artery   LV   left ventricle   RA   right atrium   RCA   right coronary artery   RV   right ventricle   TCC   transcatheter closure

This article has been cited by other articles:

				O. Rana, R. Swallow, R. Senior, and K. Greaves Detection of myocardial ischaemia caused by coronary artery-left ventricular fistulae using myocardial contrast echocardiography Eur J Echocardiogr, August 4, 2008; (2008) jen215v1. [Abstract] [Full Text] [PDF]

				B. G. Levy Praschker, A. Rama, I. Gandjbakhch, and A. Pavie Congenital bilateral coronary artery to pulmonary artery fistulas associated with left main trunk stenosis Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 360 - 361. [Abstract] [Full Text] [PDF]

				R. J. Sommer, Z. M. Hijazi, and J. F. Rhodes Jr Pathophysiology of Congenital Heart Disease in the Adult: Part I: Shunt Lesions Circulation, February 26, 2008; 117(8): 1090 - 1099. [Full Text] [PDF]

				I. Inglessis and M. J. Landzberg Interventional Catheterization in Adult Congenital Heart Disease Circulation, March 27, 2007; 115(12): 1622 - 1633. [Full Text] [PDF]

				Y.-K. Huang, M.-H. Lei, M.-S. Lu, C.-N. Tseng, J.-P. Chang, and J.-J. Chu Bilateral Coronary-to-Pulmonary Artery Fistulas Ann. Thorac. Surg., November 1, 2006; 82(5): 1886 - 1888. [Abstract] [Full Text] [PDF]

				N. Alphonso, P. V. Anagnostopoulos, A. Azakie, and T. R. Karl Undiagnosed coronary fistula causing low cardiac output syndrome after pediatric heart surgery. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 397 - 399. [Abstract] [Full Text] [PDF]

				N E Manghat, G J Morgan-Hughes, A J Marshall, and C A Roobottom Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults Heart, December 1, 2005; 91(12): 1515 - 1522. [Abstract] [Full Text] [PDF]

				J.-F. Piechaud Closing down: transcatheter closure of intracardiac defects and vessel embolisations Heart, December 1, 2004; 90(12): 1505 - 1510. [Full Text] [PDF]

				U. Demirkilic, E. Ozal, H. Bingol, F. Cingoz, C. Gunay, S. Doganci, E. Kuralay, and H. Tatar Surgical Treatment of Coronary Artery Fistulas: 15 Years' Experience Asian Cardiovasc Thorac Ann, June 1, 2004; 12(2): 133 - 138. [Abstract] [Full Text] [PDF]

				K. L. Gandy, A. G. Rebeiz, A. Wang, and J. J. Jaggers Left main coronary artery-to-pulmonary artery fistula with severe aneurysmal dilatation Ann. Thorac. Surg., March 1, 2004; 77(3): 1081 - 1083. [Abstract] [Full Text] [PDF]