title: Closure of Isolated Congenital Coronary Artery Fistula: Long-Term Outcomes and Rate of Re-intervention.
abstract: Long-term outcome after closure of isolated congenital coronary artery fistula (ICCAF) is poorly documented. To assess late outcome after ICCAF closure, a 1983-2013 retrospective study included all patients who attempted an ICCAF closure and whose follow-up was ≥1 year. ICCAF was diagnosed in 23 patients [median age 6.9 years (0.1-70.5 years), 13 children]. ICCAF was symptomatic in 12 patients (52.2 %). First intervention was either a transcatheter embolization (n = 19 patients, 82.6 %) or a surgical ligation (n = 4 patients, 17.4 %). After a follow-up of 9.0 years (2.8-33.5), neither death nor late ischemic event occurred but one patient was transplanted, because of postoperative myocardial infarction. Late ICCAF recanalization occurred in eight patients, leading to successful embolization of the shunt in all patients after a delay of 9.8 years (5.7-13.8 years) from the first intervention. Re-intervention occurred later in children (p = 0.0027), with a 50 and 37.5 % freedom from re-intervention in adults compared to a 100 and 89.0 % in children, respectively, at 1 and 6 years of follow-up. At last follow-up, coronary artery diameter had decreased from a mean z score of 12.0 ± 7.7 to a mean z score of 6.0 ± 6.0 (p = 0.002). Long-term outcome after ICCAF closure is excellent, with neither death nor late ischemic event, and a significant decrease in coronary artery diameter with time. Late follow-up is of paramount importance, as one-third of patients will require a re-intervention for late shunt recanalization.
authors.affiliation: Pediatric and Congenital Cardiac Surgery, M3C - French Reference Center for Complex Congenital Heart Diseases, Paris-Sud University, Paris-Sud School of Medicine, Marie-Lannelongue Hospital, Le Kremlin-Bicêtre, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Ponthier
authors.affiliation: Pediatric Interventional Cardiology, Marie-Lannelongue Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brenot
authors.affiliation: Pediatric and Congenital Cardiac Surgery, M3C - French Reference Center for Complex Congenital Heart Diseases, Paris-Sud University, Paris-Sud School of Medicine, Marie-Lannelongue Hospital, Le Kremlin-Bicêtre, Paris, France.|INSERM UMR 999, Marie-Lannelongue Hospital, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.affiliation: Pediatric and Congenital Cardiac Surgery, M3C - French Reference Center for Complex Congenital Heart Diseases, Paris-Sud University, Paris-Sud School of Medicine, Marie-Lannelongue Hospital, Le Kremlin-Bicêtre, Paris, France.|Pediatric Interventional Cardiology, Marie-Lannelongue Hospital, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Petit
authors.affiliation: Pediatric Interventional Cardiology, Marie-Lannelongue Hospital, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Riou
authors.affiliation: Pediatric and Congenital Cardiac Surgery, M3C - French Reference Center for Complex Congenital Heart Diseases, Paris-Sud University, Paris-Sud School of Medicine, Marie-Lannelongue Hospital, Le Kremlin-Bicêtre, Paris, France. a.baruteau@gmail.com.|Pediatric Interventional Cardiology, Marie-Lannelongue Hospital, Paris, France. a.baruteau@gmail.com.|Département de Chirurgie des Cardiopathies Congénitales, Centre Chirurgical Marie-Lannelongue, 133 avenue de la Résistance, 92350, Le Plessis-Robinson, France. a.baruteau@gmail.com.
authors.forename: Alban-Elouen
authors.initials: AE
authors.lastname: Baruteau
mesh_terms: D000328:Adult; D000368:Aged; D001159:Arterio-Arterial Fistula / Q000151:congenital / Q000601:surgery*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Congenital heart disease; Coronary artery fistula; Percutaneous closure; Shunt