Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited.
BACKGROUND
Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure.


METHODS
Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography.


RESULTS
A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery.


CONCLUSIONS
Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless the distal-most exiting segment is the primary site of occlusion.
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Bhavesh
B
Thakkar
2Department of Pediatrics,GMERS Medical College,Ahmedabad,Gujarat,India.
Nehal
N
Patel
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Vishal
V
Poptani
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Tarun
T
Madan
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Tarandip
T
Saluja
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Anand
A
Shukla
1Department of Pediatric Cardiology,U N Mehta Institute of Cardiology and Research Centre,Ahmedabad,Gujarat,India.
Nilesh
N
Oswal
3Department of Cardiothoracic Surgery,U N Mehta Institute of Cardiology & Research Centre,Ahmedabad,Gujarat,India.
Arvind
A
Bisnoi
D000293:Adolescent; D001159:Arterio-Arterial Fistula / Q000151:congenital / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
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