title: Management of coronary artery fistulae. Patient selection and results of transcatheter closure.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. armsby@cardio.tch.harvard.edu
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Armsby
authors.forename: John F
authors.initials: JF
authors.lastname: Keane
authors.forename: Megan C
authors.initials: MC
authors.lastname: Sherwood
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Forbess
authors.forename: Stanton B
authors.initials: SB
authors.lastname: Perry
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000628:therapy*; D001900:Boston / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000295:instrumentation; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018579:Patient Selection; D013536:Suture Techniques; D016896:Treatment Outcome