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,
January 1, 2009;
10(1):
175 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
e143 - e263.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
1890 - 1947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
e714 - e833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
2395 - 2451.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. M. Hijazi and S. M. Awad
Pediatric Cardiac Interventions
J. Am. Coll. Cardiol. Intv.,
December 1, 2008;
1(6):
603 - 611.
[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]
|
|
|
|
