title: Efficacy and safety of transcatheter coil embolization in congenital coronary artery fistulas guided by preinterventional cardiac computed tomography.
abstract: OBJECTIVE
  Transcatheter coil embolization of coronary artery fistulas (CAFs) has emerged as an alternative to surgical closure despite limited data in the current literature. The aim of this study was to show the efficacy of CAF closure and the benefit of the combined preinterventional use of cardiac computed tomography and coronary angiography to evaluate the feasibility and enhance the safety of this procedure by obtaining precise information about the CAF anatomy.
  
  
  METHODS
  Five consecutive patients (three men, two women, age 51-68 years) with symptomatic angiographically proven CAFs were screened for transcatheter treatment and underwent preinterventional cardiac multidetector computed tomography (MDCT).
  
  
  RESULTS
  On the basis of CAF-associated clinical symptoms, exercise-induced ischemia, coronary angiography, and cardiac MDCT, four of five patients with a CAF draining into the pulmonary artery system were considered eligible for transcatheter coil embolization, whereas in MDCT the fifth patient had multiple draining sites of the CAF and a relevant drainage into the right ventricular myocardium and was thus excluded from the procedure. Coil embolization was successfully performed in the remaining four cases without any complications. There was no residual flow through the CAF after the procedure. Clinical symptoms resolved almost completely in all four patients during a median 15.6-month follow-up.
  
  
  CONCLUSIONS
  Transcatheter coil embolization is a feasible and effective method for the treatment of symptomatic CAFs in selected cases. The adjunctive preinterventional use of cardiac MDCT with conventional angiography can identify vessels that are anatomically applicable for transcatheter closure, defer therapy in morphologically unsuitable complex cases, and thus optimize the safety of the procedure.
authors: Department of Cardiology/Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen, Germany. sreith@ukaachen.de
authors: Sebastian
authors: S
authors: Reith
authors: Sebastian D
authors: SD
authors: Reinartz
authors: Mathias
authors: M
authors: Burgmaier
authors: Nikolaus
authors: N
authors: Marx
authors: Andreas H
authors: AH
authors: Mahnken
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000151:congenital / Q000000981:diagnostic imaging / Q000628:therapy*