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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

View larger version (66K): [in a new window]   Figure 1 Coronary artery fistula from right coronary artery to right atrium. (A) Single insertion site into right atrium (arrow). (B) Complete occlusion following transvenous placement of single coil (arrow).

View larger version (81K): [in a new window]   Figure 2 Coronary artery fistula from left coronary artery to left atrium. (A) Arteriovenous wire loop enabling passage of venous catheter across the atrial septum into the fistula drainage site (arrow). (B) Angiogram following transvenous deployment of a 12-mm Rashkind device (arrow), showing coronary artery fistula occlusion and coronary artery side branches that were not evident in angiograms performed without balloon occlusion.

View larger version (22K): [in a new window]   Figure 3 The transcatheter closure patient group: coronary artery fistulae origin and drainage sites. Circ = circumflex artery; CS = coronary sinus; LA = left atrium; LAD = left anterior descending coronary artery; LMCA = left main coronary artery; LV = left ventricle; PA = pulmonary artery; RA = right atrium; RCA = right coronary artery; RCC = right coronary cusp; RV = right ventricle; RVOT = right ventricular outflow tract; SVC = superior vena cava.

View larger version (49K): [in a new window]   Figure 4 Device delivery in the transcatheter closure patient group. (A) Occlusion device used. (B) Catheter approach for device delivery.

View larger version (42K): [in a new window]   Figure 5 Residual flow following transcatheter closure of coronary artery fistula by angiography and echocardiography.

View larger version (164K): [in a new window]   Figure 6 Angiogram showing tortuous coronary artery fistula from right coronary artery to coronary sinus (Table 1, Patient 1): occlusion not attempted as antegrade access to coronary artery fistula unsuccessful and catheter lengths insufficient to reach distal fistula from a retrograde approach.