title: Transcatheter closure of coronary artery fistulas in infants and children: A French multicenter study.
abstract: OBJECTIVE
  The short-term efficacy and safety of transcatheter closure (TCC) for the management of coronary artery fistulas (CAFs) was investigated in pediatric patients.
  
  
  BACKGROUND
  CAFS are rare with potentially severe complications and their management is still a matter of debate. Percutaneous closure appears to be the treatment of choice in anatomically suitable vessels but limited data are available in the pediatric population.
  
  
  METHODS
  This retrospective, observational, multicenter, national study included patients under 16 years of age who underwent TCC of a congenital CAF. Patients with additional congenital heart defect were excluded.
  
  
  RESULTS
  61 patients (36 girls, 25 boys) with a median age of 0.6 year [0-15.4] at diagnosis and 3.9 years [0-16] at procedure were included. The CAF was large in 48 patients (79%); it was distal in 23 (38%) and proximal in 22 (36%). Most patients (77%) were asymptomatic at diagnosis. Clinical signs of congestive heart failure were present in seven patients (11%). Perioperative complications included three cases of ST elevation myocardial infarction (exclusively during attempted closure of a distal CAF), three devices migrations, and one case of leg ischemia. One patient died after surgical closure of a large distal CAF that could not be closed by TCC. Follow-up data were collected for 43 patients (70%) for a median of 91 days [0-4,824]. The Kaplan-Meyer estimate for complete occlusion at 2 years was 73 ± 7.6%.
  
  
  CONCLUSIONS
  TCC in the pediatric population appears to be effective and associated with few complications.
authors.affiliation: Institut Du Thorax, Centre Hospitalier Universitaire De Nantes, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Mottin
authors.affiliation: Centre Médico-Chirurgical De Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Baruteau
authors.affiliation: Hôpital Necker Enfants Malades, Assistance Publique Des Hôpitaux De Paris, France.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.affiliation: Institut Cardiologique Paris Sud, Massy, France.
authors.forename: François J
authors.initials: FJ
authors.lastname: Piéchaud
authors.affiliation: Centre Hospitalier Régional Universitaire De Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Godart
authors.affiliation: Centre Hospitalier Universitaire Gabriel Montpied, Clermont Ferrand, France.
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
authors.affiliation: Centre Médico-Chirurgical De Marie Lannelongue, Le Plessis Robinson, France.|Centre Hospitalier Universitaire De Toulouse, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Hascoet
authors.affiliation: Institut Du Thorax, Centre Hospitalier Universitaire De Nantes, France.
authors.forename: Laurianne
authors.initials: L
authors.lastname: Le Gloan
authors.affiliation: Institut Du Thorax, Centre Hospitalier Universitaire De Nantes, France.
authors.forename: Karine Warin
authors.initials: KW
authors.lastname: Fresse
authors.affiliation: Institut Du Thorax, Centre Hospitalier Universitaire De Nantes, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Guyomarch
authors.affiliation: Institut Cardiologique Paris Sud, Massy, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Bouzguenda
authors.affiliation: Hôpital Necker Enfants Malades, Assistance Publique Des Hôpitaux De Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Malekzadeh-Milani
authors.affiliation: Centre Médico-Chirurgical De Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Petit
authors.affiliation: Institut Du Thorax, Centre Hospitalier Universitaire De Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Guérin
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000209:etiology; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*
keywords: coronary artery fistulas; interventional cardiology; pediatric; percutaneous closure