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Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited

Published online by Cambridge University Press:  28 April 2014

Bhavesh Thakkar ,
Nehal Patel ,
Vishal Poptani ,
Tarun Madan ,
Tarandip Saluja ,
Anand Shukla ,
Nilesh Oswal  and
Arvind Bisnoi
Bhavesh Thakkar*
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Nehal Patel
Affiliation:
Department of Pediatrics, GMERS Medical College, Ahmedabad, Gujarat, India
Vishal Poptani
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Tarun Madan
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Tarandip Saluja
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Anand Shukla
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Nilesh Oswal
Affiliation:
Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
Arvind Bisnoi
Affiliation:
Department of Cardiothoracic Surgery, U N Mehta Institute of Cardiology & Research Centre, Ahmedabad, Gujarat, India
*
Correspondence to: Dr B. Thakkar, Associate Professor, Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India. Tel: +91 9898022444; Fax: +91 (79) 22682092; E-mail: [email protected]
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Abstract

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. Method: 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. Conclusion: 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.

Keywords

Congenital heart diseasecardiac interventioncoronary fistuladevice
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 670 - 680
Copyright
© Cambridge University Press 2014 

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Footnotes

Meeting Presentation: was presented at Annual Conference of Pediatric cardiac society of India October, 2012, Chennai, India

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