Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry

Background: Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. Methods: A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. Results: Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01–1) and 4.2 kg (1.7–10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1–18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. Conclusions: Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.

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Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited

Cardiology in the Young ◽

10.1017/s1047951114000614 ◽

2014 ◽

Vol 25 (4) ◽

pp. 670-680 ◽

Cited By ~ 6

Author(s):

Bhavesh Thakkar ◽

Nehal Patel ◽

Vishal Poptani ◽

Tarun Madan ◽

Tarandip Saluja ◽

...

Keyword(s):

Coronary Artery ◽

Transcatheter Closure ◽

Coronary Artery Fistula ◽

Artery Occlusion ◽

Parent Artery ◽

Surgical Closure ◽

Parent Artery Occlusion ◽

Angiographic Data ◽

The Right

AbstractBackground: Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. Method: Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. Results: A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery. Conclusion: Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless the distal-most exiting segment is the primary site of occlusion.

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Prenatal diagnosis of isolated coronary artery fistulas: progression and outcome in five cases

Cardiology in the Young ◽

10.1017/s1047951115001535 ◽

2015 ◽

Vol 26 (5) ◽

pp. 915-920 ◽

Cited By ~ 5

Author(s):

Gurleen K. Sharland ◽

Laura Konta ◽

Shakeel A. Qureshi

Keyword(s):

Coronary Artery ◽

Cardiac Failure ◽

Transcatheter Closure ◽

Coronary Artery Fistula ◽

Congestive Cardiac Failure ◽

Fetal Life ◽

Circumflex Coronary Artery ◽

Coronary Artery Fistulas ◽

The Right

AbstractObjectivesThe aim of this study was to describe the clinical characteristics, progression, treatment, and outcomes in isolated coronary artery fistula cases diagnosed prenatally.MethodsWe carried out a retrospective review of babies diagnosed prenatally with coronary artery fistulas between January, 2000 and December, 2013; five fetuses were included. Echocardiographic features and measurements were noted during pregnancy and after birth. Treatment and outcome were noted.ResultsGestational age at initial diagnosis was between 19 and 22 weeks; four coronary artery fistulas originated from the right and one from the left circumflex coronary artery. Drainage was into the right atrium in four cases and into the left ventricle in one case. There was cardiomegaly in two cases at the initial scan. The size of the fistulas increased during pregnancy in all except one. All prenatal diagnoses were confirmed postnatally. Among all, two patients developed congestive cardiac failure soon after birth and required transcatheter closure of the coronary artery fistula, 5 and 17 days after birth, respectively; three patients remained asymptomatic, and all of them showed progressive dilation of the feeding artery and had closure of the fistula at 20 months, 4 years, and 7 years of age, respectively. During the follow-up period, which ranged 2–14 years, all the patients were alive and well.ConclusionsCoronary artery fistulas can be diagnosed accurately during fetal life. Some babies may develop congestive cardiac failure soon after birth requiring early treatment. Those treated conservatively should be kept under review as intervention may be required later.

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Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical closure

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01769-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiaoyong Wang ◽

Chengcheng Pang ◽

Xiaobing Liu ◽

Shushui Wang ◽

Zhiwei Zhang ◽

...

Keyword(s):

Coronary Artery ◽

Pediatric Patients ◽

Group Versus ◽

Final Analysis ◽

Coronary Artery Fistula ◽

Surgical Closure ◽

Major Complications ◽

Congenital Coronary Artery Fistula ◽

The Mean

Abstract Objectives Transcatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited. Methods We retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups. Results In total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up. Conclusions TCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.

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Coronary Artery Fistulas: Case Series and Literature Review

Cardiology ◽

10.1159/000447445 ◽

2016 ◽

Vol 136 (2) ◽

pp. 93-101 ◽

Cited By ~ 7

Author(s):

Christina Karazisi ◽

Peter Eriksson ◽

Mikael Dellborg

Keyword(s):

Coronary Artery ◽

Watchful Waiting ◽

Transcatheter Closure ◽

Incidental Finding ◽

Case Reports ◽

Case Series ◽

Surgical Closure ◽

Asymptomatic Patients ◽

Coronary Artery Fistulas

Congenital coronary artery fistulas are rare anomalies. As coronary angiography and multidetector computed tomography have become more accessible, they have been increasingly used in the investigation of chest pain and heart failure. Coronary artery fistulas are often an incidental finding, which raises the question of how patients with this condition should be managed. Intervention with either transcatheter closure or surgical closure is often technically possible. Many patients are asymptomatic early after closure. However, follow-up studies have shown post-closure sequelae, such as residual leakage, thrombosis with or without myocardial infarction, and coronary stenosis. Therefore, there has been a shift from intervention towards watchful waiting in asymptomatic patients. In this article, we review the published literature on the natural history and treatment outcomes in individuals with coronary artery fistulas. We present case reports from our clinic and discuss the management of incidental findings of coronary artery fistulas.

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Midterm follow up of transcatheter closure of coronary artery fistula with Nit-Occlud® patent ductus arteriosus coil

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01999-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hamid Amoozgar ◽

Mohammad Reza Edraki ◽

Amir Naghshzan ◽

Nima Mehdizadegan ◽

Hamid Mohammadi ◽

...

Keyword(s):

Coronary Artery ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Coronary Artery Fistula ◽

Fistula Tract ◽

Conventional Coronary Angiography ◽

Residual Shunt ◽

Mortality And Morbidity ◽

Before And After

Abstract Background Coronary artery fistula (CAF) is a rare congenital anomaly with a challenging scenario in children. This study reports our experience in transcatheter closure of CAF with Nit-Occlude PDA coil and midterm clinical and imaging follow-up. Methods Twelve children with congenital CAF between 2009 and 2019, mean age 2.05 ± 2.05 years (4 days to 7.2 years), mean weight 8.8 ± 4.83 (2.8–17 kg), who underwent transcatheter closure with PFM coil at the Namazi hospital, Shiraz, Iran, were reported. Echocardiography and electrocardiogram were done before and after the procedure (early, 3, and 6 months after), and Multi-slice computerized tomography or conventional coronary angiography was performed at least one year after closure. Results In a median follow-up of 5.5 years (range 13 months to 8 years), retrogradely closed fistula had no residual, and the fistula tract was wholly occluded, but in most anterogradely closed fistula, had a small residual, which made the fistula tract open and need additional coil closure. Conclusions Transcatheter closure of CAF with PFM coil is feasible and effective with low mortality and morbidity, although antegrade closure with this device may be accompanied by residual shunt and need for multiple coil insertion.

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Left Atrial Appendage Enlarged by Coronary Artery Fistula after Surgical Closure of Appendage

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0034-1387823 ◽

2014 ◽

Vol 03 (01) ◽

pp. 031-032 ◽

Cited By ~ 1

Author(s):

Tamaki Takano ◽

Haruki Tanaka ◽

Takamitsu Terasaki

Keyword(s):

Coronary Artery ◽

Left Atrial ◽

Left Atrial Appendage ◽

Coronary Artery Fistula ◽

Atrial Appendage ◽

Surgical Closure

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Mid- to long-term follow-up of pediatric patients with coronary artery fistula

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2015.05.015 ◽

2016 ◽

Vol 115 (7) ◽

pp. 571-576 ◽

Cited By ~ 9

Author(s):

Mao-Hung Lo ◽

I-Chun Lin ◽

Kai-Sheng Hsieh ◽

Chien-Fu Huang ◽

Shao-Ju Chien ◽

...

Keyword(s):

Coronary Artery ◽

Pediatric Patients ◽

Coronary Artery Fistula ◽

Long Term Follow Up

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A case report of a coronary artery fistula to coronary sinus with giant aneurysm: risk does not end with repair

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa297 ◽

2020 ◽

Author(s):

Giulia Poretti ◽

Mauro Lo Rito ◽

Alessandro Varrica ◽

Alessandro Frigiola

Keyword(s):

Coronary Artery ◽

Coronary Sinus ◽

Giant Aneurysm ◽

Coronary Aneurysm ◽

Coronary Artery Fistula ◽

Percutaneous Closure ◽

Low Flow ◽

Circumflex Artery ◽

Coronary Aneurysms

Abstract Background Isolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08–0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left–right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication. Case summary We report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia. Discussion Management of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.

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