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Closure of coronary artery fistula in childhood: treatment techniques and long-term follow-up

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Abstract

Introduction

Coronary artery fistula (CAF) is a rare congenital anomalous connection between the coronary arteries (CA) and a cardiac chamber or great vessel. Treatment options of symptomatic CAF consist of transcatheter or surgical closure.

Methods

Retrospective analysis of all patients with CAF diagnosed between 1993 and 2014 concerning treatment approaches and follow-up after closure.

Results

In a cohort of more than 25000 patients, 194 (<0.01 %) were diagnosed to have CAF. Median age at diagnosis was 6 months (0 day–18 years). Treatment was indicated in ten patients (5.2 %). Six patients (60 %) were treated by catheter interventional approach using Coils (three patients), Amplatzer Vascular Plugs (two patients) and Amplatzer Duct Occluder (one patient). One of these patients showed a significant residual shunt through the fistula 5 days after interventional closure, necessitating surgical removal of the device and closure of CAF. At a median follow-up of 7 (range 2–12) years, the remaining five patients showed successfully closed CAF without causing thrombosis of the CA. Control angiography in three patients showed persistent dilated CA. Surgical closure of CAF was performed in four (40 %) patients; in two as an isolated procedure and in the remaining two as a part of another congenital cardiac corrective procedure.

Conclusions

CAF in paediatric cardiology patients is a very rare finding. Intervention in childhood is rarely needed; nevertheless, it is known that small fistulas may become relevant in adulthood. Transcatheter closure techniques are effective and are considered the treatment of choice, especially in isolated CAF.

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References

  1. Sievert H (2007) Percutaneous interventions for congenital heart disease [Internet]. London; Boca Raton, FL: Informa Healthcare; Distributed in North and South America by Taylor & Francis [cited 2014 Sep 2]

  2. Qureshi SA (2006) Coronary arterial fistulas. Orphanet J Rare Dis 1:51

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 21(1):28–40

    Article  CAS  PubMed  Google Scholar 

  4. Sherwood MC, Rockenmacher S, Colan SD, Geva T (1999) Prognostic significance of clinically silent coronary artery fistulas. Am J Cardiol 83(3):407–411

    Article  CAS  PubMed  Google Scholar 

  5. Schleich JM, Rey C, Gewillig M, Bozio A (2001) Spontaneous closure of congenital coronary artery fistulas. Heart Br Card Soc 85(4):E6

    Article  CAS  Google Scholar 

  6. Gowda RM, Vasavada BC, Khan IA (2006) Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 107(1):7–10

    Article  PubMed  Google Scholar 

  7. Gowda ST, Forbes TJ, Singh H, Kovach JA, Prieto L, Latson LA et al (2013) 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 Off J Soc Card Angiogr Interv 82(1):132–142

    Article  Google Scholar 

  8. Harikrishnan S, Bimal F, Ajithkumar V, Bhat A, Krishnamoorthy KM, Sivasubramonian S et al (2011) Percutaneous treatment of congenital coronary arteriovenous fistulas. J Intervent Cardiol 24(3):208–215

    Article  PubMed  Google Scholar 

  9. Jama A, Barsoum M, Bjarnason H, Holmes DR, Rihal CS (2011) Percutaneous closure of congenital coronary artery fistulae: results and angiographic follow-up. JACC Cardiovasc Interv 4(7):814–821

    Article  PubMed  Google Scholar 

  10. Tirilomis T, Aleksic I, Busch T, Zenker D, Ruschewski W, Dalichau H (2005) Congenital coronary artery fistulas in adults: surgical treatment and outcome. Int J Cardiol 98(1):57–59

    Article  PubMed  Google Scholar 

  11. Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH (1979) Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 59(5):849–854

    Article  CAS  PubMed  Google Scholar 

  12. Wang S-S, Zhang Z-W, Qian M-Y, Zhuang J, Zeng G-H (2013) Transcatheter closure of coronary arterial fistula in children and adolescents. Pediatr Int Off J Jpn Pediatr Soc

  13. Uysal F, Bostan OM, Semizel E, Signak IS, Asut E, Cil E (2013) Congenital Anomalies of coronary arteries in children: the evaluation of 22 patients. Pediatr Cardiol

  14. Wong KT, Menahem S (2000) Coronary arterial fistulas in childhood. Cardiol Young 10(1):15–20

    Article  CAS  PubMed  Google Scholar 

  15. Welisch E, Norozi K, Burrill L, Rauch R (2015) Small coronary artery fistulae in childhood: a 6-year experience of 31 cases in a tertiary paediatric cardiac centre. Cardiol Young 14:1–5

    Google Scholar 

  16. Luo L, Kebede S, Wu S, Stouffer GA (2006) Coronary artery fistulae. Am J Med Sci 332(2):79–84

    Article  CAS  PubMed  Google Scholar 

  17. Sunder KR, Balakrishnan KG, Tharakan JA, Titus T, Pillai VR, Francis B et al (1997) Coronary artery fistula in children and adults: a review of 25 cases with long-term observations. Int J Cardiol 58(1):47–53

    Article  CAS  PubMed  Google Scholar 

  18. Thakkar B, Patel N, Poptani V, Madan T, Saluja T, Shukla A et al (2015) Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited. Cardiol Young 25(4):670–680

    Article  PubMed  Google Scholar 

  19. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol 52(23):e143–e263

    Article  PubMed  Google Scholar 

  20. Said SM, Burkhart HM, Schaff HV, Connolly HM, Phillips SD, Suri RM et al (2013) Late outcome of repair of congenital coronary artery fistulas—a word of caution. J Thorac Cardiovasc Surg 145(2):455–460

    Article  PubMed  Google Scholar 

  21. Reidy JF, Anjos RT, Qureshi SA, Baker EJ, Tynan MJ (1991) Transcatheter embolization in the treatment of coronary artery fistulas. J Am Coll Cardiol 18(1):187–192

    Article  CAS  PubMed  Google Scholar 

  22. Reidy JF, Jones OD, Tynan MJ, Baker EJ, Joseph MC (1985) Embolisation procedures in congenital heart disease. Br Heart J 54(2):184–192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Reidy JF, Sowton E, Ross DN (1983) Transcatheter occlusion of coronary to bronchial anastomosis by detachable balloon combined with coronary angioplasty at same procedure. Br Heart J 49(3):284–287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Strecker T, Hakami L, Singer H, Weyand M, Cesnjevar R (2006) Congenital coronary artery fistula draining into the right ventricle: successful surgical closure after failed transcatheter coil embolization. Thorac Cardiovasc Surg 54(1):61–63

    Article  CAS  PubMed  Google Scholar 

  25. Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE (2002) Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol 39(6):1026–1032

    Article  PubMed  Google Scholar 

  26. Xiao Y, Gowda ST, Chen Z, Delaney JW, Amin Z, Latson LA et al (2015) Transcatheter closure of coronary artery fistulae: considerations and approaches based on fistula origin: transcatheter closure of coronary artery Fistulae. J Intervent Cardiol 28(4):380–389

    Article  PubMed  Google Scholar 

  27. Wang C, Zhou K, Li Y, Qiao L, Wang Y, Shi X et al (2014) Percutaneous transcatheter closure of congenital coronary artery fistulae with patent ductus arteriosus occluder in children: focus on patient selection and intermediate-term follow-up results. J Invasive Cardiol 26(7):339–346

    PubMed  Google Scholar 

  28. Gribaa R, Slim M, Ouali S, Neffati E, Boughzela E (2014) Transcatheter closure of a congenital coronary artery to right ventricle fistula: a case report. J Med Case Rep 8(1):432

    Article  PubMed  PubMed Central  Google Scholar 

  29. Perry SB, Rome J, Keane JF, Baim DS, Lock JE (1992) Transcatheter closure of coronary artery fistulas. J Am Coll Cardiol 20(1):205–209

    Article  CAS  PubMed  Google Scholar 

  30. Kharouf R, Cao Q-L, Hijazi ZM (2007) Transcatheter closure of coronary artery fistula complicated by myocardial infarction. J Invasive Cardiol 19(5):E146–E149

    PubMed  Google Scholar 

  31. Dietze T, Paliege R, Berger D, Gradaus R, Neuzner J (2014) Closure of a coronary to pulmonary artery fistula by radiofrequency catheter ablation in the pulmonary artery. Clin Res Cardiol Off J Ger Card Soc 103(1):73–74

    Article  Google Scholar 

  32. Gowda ST, Latson LA, Kutty S, Prieto LR (2011) Intermediate to long-term outcome following congenital coronary artery fistulae closure with focus on thrombus formation. Am J Cardiol 107(2):302–308

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Paediatric Cardiology, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Martin Christmann, Ricarda Hoop, Daniel Quandt, Walter Knirsch & Oliver Kretschmar

  2. Paediatric Cardiology, Cantonal Hospital Graubunden, Chur, Switzerland

    Ricarda Hoop

  3. Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland

    Hitendu Dave

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  1. Martin Christmann
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  2. Ricarda Hoop
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Correspondence to Martin Christmann.

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Christmann, M., Hoop, R., Dave, H. et al. Closure of coronary artery fistula in childhood: treatment techniques and long-term follow-up. Clin Res Cardiol 106, 211–218 (2017). https://doi.org/10.1007/s00392-016-1041-6

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  • DOI: https://doi.org/10.1007/s00392-016-1041-6

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