Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-11T01:12:25.617Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  28 April 2014

Bhavesh Thakkar ,
Nehal Patel ,
Vishal Poptani ,
Tarun Madan ,
Tarandip Saluja ,
Anand Shukla ,
Nilesh Oswal  and
Arvind Bisnoi
Bhavesh Thakkar*
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Nehal Patel
Affiliation:
Department of Pediatrics, GMERS Medical College, Ahmedabad, Gujarat, India
Vishal Poptani
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Tarun Madan
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Tarandip Saluja
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Anand Shukla
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Nilesh Oswal
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Arvind Bisnoi
Affiliation:
Department of Cardiothoracic Surgery, U N Mehta Institute of Cardiology & Research Centre, Ahmedabad, Gujarat, India
*
Correspondence to: Dr B. Thakkar, Associate Professor, Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India. Tel: +91 9898022444; Fax: +91 (79) 22682092; E-mail: bthakkarin@yahoo.co.in
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: 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.

Keywords

Congenital heart diseasecardiac interventioncoronary fistuladevice
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 670 - 680
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Meeting Presentation: was presented at Annual Conference of Pediatric cardiac society of India October, 2012, Chennai, India

References

1. McNamara, JJ, Gross, RE. Congenital coronary artery fistula. Surgery 1969; 65: 59–69.Google ScholarPubMed
2. Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary angiography. Catheter Cardiovasc Diagn 1990; 21: 28–40.Google Scholar
3. Fernandes, ED, Kadivar, H, Hallman, GL, et al. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg 1992; 54: 732–737.Google Scholar
4. Levin, DC, Fellows, KE, Abrams, HL. Hemodynamically significant primary anomalies of the coronary arteries: angiographic aspects. Circulation 1978; 58: 25–34.CrossRefGoogle ScholarPubMed
5. Liberthson, RR, Sagar, K, Berkoben, JP, et al. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 1979; 59: 849–854.Google Scholar
6. Schleich, JM, Rey, C, Gewillig, M, et al. Spontaneous closure of congenital coronary artery fistulas. Heart 2001 Apr; 85: E6.Google Scholar
7. Latson, LA. Coronary artery fistulas: how to manage them. Catheter Cardiovasc Interv 2007; 70: 110–116.CrossRefGoogle Scholar
8. Jama, A, Barsoum, M, Jarnason, HB, et al. Percutaneous closure of congenital coronary artery fistulae, results and angiographic follow up. JACC 2011; 4: 814–821.Google ScholarPubMed
9. Hiraishi, S, Misawa, H, Horiguchi, Y, et al. Effect of suture closure of coronary artery fistula on aneurysmal coronary artery and myocardial ischemia. Am J Cardiol. 1998; 81: 1263–1267.Google Scholar
10. Shyam Sunder, KR, Balakrishnan, KG, Tharakan, JA, et al. Coronary artery fistula in children and adults: a review of 25 cases with long-term observations. In J Cardiol 1997; 58: 47–53.Google Scholar
11. Mavroudis, C, Backer, CL, Rocchini, AP, et al. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg 1997; 63: 1235–1242.Google Scholar
12. Wang, S, Wu, Q, Hu, S, et al. Surgical treatment of 52 patients with congenital coronary artery fistulas. Chin Med J(Engl) 2001; 114: 752–755.Google Scholar
13. Baim, DS, Kline, H, Silverman, JF. Bilateral coronary artery – pulmonary artery fistulas. Report of five cases and review of the literature. Circulation 1982; 65: 810–815.Google Scholar
14. Holzer, R, Johnson, R, Ciotti, G, et al. Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature. Cardiol Young 2004; 14: 380–385.Google Scholar
15. Schumacher, G, Roithmaier, A, Lorenz, HP, et al. Congenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects. Thorac Cardiovasc Surg 1997; 45: 287–294.Google Scholar
16. Xu, L, Xu, Z-Y, Jiang, S-L, et al. Transcatheter closure of coronary artery fistula in children. Chin Med J 2010; 123: 822–826.Google Scholar
17. Behera, SK, Danon, S, Levi, DS, et al. Transcatheter closure of coronary artery fistulae using the Amplatzer Duct Occluder. Catheter Cardiovasc Interv 2006; 68: 242–248.CrossRefGoogle ScholarPubMed
18. Fischer, G, Apostolopoulou, SC, Rammos, S, et al. Transcatheter closure of coronary arterial fistulas using the new Amplatzer® vascular plug. Cardiol Young 2007; 17: 283–287.Google Scholar
19. Skimming, JW, Gessner, IH, Victorica, BE, et al. Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons. Pediatr Cardiol 1995; 16: 38–41.Google Scholar
20. Qureshi, SA, Tynan, M. Catheter closure of coronary artery fistulas. J Interv Cardiol 2001; 14: 299–308.CrossRefGoogle ScholarPubMed
21. Cheung, DL, Au, WK, Cheung, HH, et al. Coronary artery fistulas: long-term results of surgical correction. Ann Thorac Surg 2001; 71: 190–195.Google Scholar
22. Malekahmadi, M, Shahmohmadi, A. Surgical outcome of caoronary artery fistulas repair in children. Pediatr Cardiol 2005; 26: 328–330.Google Scholar
23. Armsby, LR, Keane, JF, Sherwood, MC, et al. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol 2002; 39: 1026–1032.Google Scholar
24. Harikrishnan, SP, Bimal, F, Ajithkumar, V, et al. Percutaneous treatment of congenital coronary arteriovenous fistulas. J Interven Cardiol 2011; 24: 208–215.CrossRefGoogle ScholarPubMed
25. Collins, N, Mehta, R, Benson, L, et al. Percutaneous coronary artery fistula closure in adults: technical and procedural aspects. Cathet Cardiovas Interv 2007; 69: 872–880.Google Scholar
26. Okubo, M, Nykanen, D, Benson, L. Outcomes of transcatheter embolization in the treatment of coronary artery fistulas. Cathet Cardiovasc Intervent 2001; 52: 510–517.Google Scholar
27. Gowda, ST, Forbes, TJ, Singh, H, et al. Remodeling and thrombosis following closure of coronary artery fistula with review of management: large distal coronary artery fistula – to close or not to close? Catheter Cardiovasc Interv 2013; 82: 132–142.Google Scholar
28. Gowda, ST, Latson, LA, Kutty, S, Prieto, LR. Intermediate to long-term outcome following congenital coronary artery fistulae closure with focus on thrombus formation. Am J Cardiol 2011; 107: 302–308.Google Scholar
29. Horiuchi, T, Abe, T, Tanaka, S, et al. Congenital coronary arteriovenous fistulas. Ann Thorac Surg 1971; 11: 102–112.Google Scholar
30. Sakakibara, S, Yokoyama, M, Takao, A, et al. Coronary arteriovenous fistula: nine operated cases. Am Heart J 1966; 72: 307– 314.Google Scholar