[Endovascular treatment of coronary arterial fistulae in children and adults].
The authors report their experience of endovascular treatment of coronary fistulae in 25 patients aged 2 to 77 years (median 29 years) who underwent 30 interventional catheterisation procedures. The origin of the fistulae was variable: left coronary (14 cases), right coronary (6 cases) and bilateral (5 cases) as were the sites of drainage: right atrium (5 cases), right ventricle (8 cases) pulmonary artery (7 cases) and bronchial artery (5 cases). Different materials were used: releasable balloons (9 cases), coils (17 cases), microparticles (5 cases) and Amplatzer occluder and plug (2 cases). The result, judged by occlusion or sub-occlusion of the given pedicle, was a success in 92% of cases. Total or sub-total occlusion of the fistula was obtained in 22 patients (88%); 2 patients had residual fistulae due to non-embolisation of the pedicle; in one patient, it was not possible to embolise the pedicle despite two attempts. A single serious complication, ventricular fibrillation during the catheterisation, was observed but without a sequel. Follow-up ranged from 6 to 176 months; 4 patients died of other causes, 3 were lost to follow-up; one coronaro-pulmonary fistula recurred but no other recurrence was observed in the other patients. The authors conclude that embolisation is the treatment of choice for coronary fistulae providing the cases are managed by teams trained in the use of different materials. The choice of material of embolisation should be adapted to the anatomical conditions which determine the success rate and the absence of complications.
Brenot
P
P
Service de radiologie cardio-vasculaire, Hôpital Marie-Lannelongue, 133, av. de la Résistance, 92350 Le Plessis-Robinson. p.brenot@ccml.fr
Riou
J-Y
JY
Losay
J
J
Petit
J
J
Lambert
V
V
Angel
C-Y
CY
D000293:Adolescent; D000328:Adult; D000368:Aged; D001159:Arterio-Arterial Fistula / Q000628:therapy; D021721:Balloon Occlusion / Q000295:instrumentation; D001981:Bronchial Arteries / Q000002:abnormalities; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000002:abnormalities; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology