Transcatheter closure of coronary arterial fistula in children and adolescents.

BACKGROUND

Transcatheter closure of coronary arterial fistula (CAF) is being utilized increasingly as an alternative to surgical closure, but most of the literature on transcatheter closure of CAF in children and adolescents consists of case reports and reports of small series. The aim of this study was therefore to describe our experience of percutaneous closure of CAF in children and adolescents.

METHODS

Between April 1998 and December 2012, 37 children and adolescents with congenital CAF underwent percutaneous transcatheter closure. After aortic root angiography and selective coronary angiography, a guidewire was positioned to the fistula. In some cases, an arteriovenous wire loop (AV loop) was created. The sheath passed along the wire to the site of the desired occlusion of the fistula. One or more occlusion devices were selected to embolize the fistula.

RESULTS

Occlusion devices were placed in 33 procedures (32 patients). Occlusion was unsuccessful in five patients. Duct occluders were placed in 12 procedures, coils in 11 (10 patients), muscular ventricular septal occluders in six, and vascular plugs in four procedures. The tricuspid valve was injured in two patients. One patient with a giant CAF aneurysm had a thrombosis within the aneurysm after transcatheter closure. There were no deaths, fistula dissection or myocardial infarction.

CONCLUSION

Transcatheter closure of CAF is feasible in anatomically suitable cases, but injury to the tricuspid valve involved with AV loop methods can occur in closure procedures, and thrombus formation is possible in the blind pouch of the residual fistula after closure. Long-term follow up after fistula closure is necessary.