Transcatheter embolisation of coronary artery fistulae.
BACKGROUND
Most children with coronary artery fistulae are asymptomatic, but because of associated late morbidity, early intervention is usually indicated.


OBJECTIVE
To assess the outcome following transcatheter embolisation of coronary artery fistulae.


METHODS
Six children, with a median age of 9.5 years (range: 1.3-13.7 years), underwent transcatheter embolisation of coronary artery fistulae. Four patients had simple fistulae, which drained from the right coronary artery to the right ventricle (n = 2), the left coronary artery to the right ventricle (n = 1), or the left coronary artery to the coronary sinus (n = 1). Two patients had complex multiple fistulae arising from both coronary arteries, which communicated with either the right ventricle or the pulmonary arterial system.


RESULTS
A stable position with a 5-Fr coronary catheter was obtained proximally and a 3-Fr coaxial catheter was advanced through the coronary catheter to a distal position in the coronary artery fistulae. The number of embolisation microcoils used per procedure ranged from one to 12, and the coil diameter ranged from 3 mm. Polyvinyl alcohol foam embolisation particles (1000 microm) were used to embolise small fistulae to the pulmonary arterial tree. Complete occlusion was obtained in four patients, while two children were left with insignificant residual shunts. There were no early or late cardiac complications.


CONCLUSIONS
Transcatheter embolisation of coronary artery fistulae is a safe and effective therapy in patients with suitable anatomy.
Justo
R N
RN
The Queensland Centre for Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia. robert_justo@health.qld.gov.au
Slaughter
R E
RE
Whight
C M
CM
Radford
D J
DJ