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Abo-Salem E, Decanio R, Leesar M, Abruzzo T, Vu D, Alkhawam H, Ristagno R. Percutaneous closure of right coronary to superior vena cava fistula. Future Cardiol 2019; 15:161-167. [PMID: 31148466 DOI: 10.2217/fca-2018-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Coronary artery to superior vena cava (SVC) fistula is a very rare congenital anomaly of the heart. It typically follows the course of sinoatrial-nodal branch. It can originate from the right coronary or circumflex artery. In the majority of cases, it terminates in the SVC close to the right atrium junction. Only five cases were treated in literature successfully through a transcatheter approach. We present a case with a symptomatic right coronary artery to SVC fistula treated with a unique percutaneous embolization using a guidewire loop/balloon occlusion technique. Controlled access and embolization of the fistula was achieved by through-and-through guidewire access across the coronary fistula from the arterial groin access to the venous groin access with balloon occlusion of the coronary artery fistula while detachable coils were positioned.
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Affiliation(s)
- Elsayed Abo-Salem
- Center for Comprehensive Cardiovascular Care, Saint Louis University Hospital, St. Louis, MO 63110, USA
| | - Raymond Decanio
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Massoud Leesar
- Department of Cardiology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Todd Abruzzo
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Doan Vu
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Hassan Alkhawam
- Center for Comprehensive Cardiovascular Care, Saint Louis University Hospital, St. Louis, MO 63110, USA
| | - Ross Ristagno
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
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Coronary artery fistulas in children. Evaluation with 64-slice multidetector CT. Herz 2013; 38:729-35. [PMID: 23558553 DOI: 10.1007/s00059-013-3786-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES There are various types of coronary artery fistulas (CAF) with complex shapes. Therefore, it is important to make a correct diagnosis and to understand the relationship of the CAF to the adjacent structures before transcatheter occlusion or surgery. This study evaluated the feasibility of using 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF. METHODS Two readers who were blinded to the results of echocardiography, intervention, or surgery retrospectively evaluated the coronary MDCT appearances of CAF in 10 patients (4 boys and 6 girls; mean age, 2.9 years; range, 1-6 years). The origin, course, and distal entry site of the fistula were determined. The diameters of the origin and the distal entry site were measured and compared with those seen during intervention or surgery. RESULTS The origin, course, and distal vessel entry site of the CAF were clearly outlined in all patients by MDCT. The distal vessel draining site involved a single entry vessel in all patients. Seven fistulas involved the right coronary artery, and three involved the left coronary artery. Four fistulas drained into the right ventricle, four into the right atrium, and two into the left ventricle. The diagnosis of CAF using MDCT was in accordance with diagnoses made during intervention or surgery. There was an excellent correlation between MDCT and transcatheter occlusion in quantifying the diameters of the origin and distal entry site (R = 0.90 and 0.92, respectively, P < 0.05). CONCLUSION Coronary 64-slice MDCT angiography depicted the whole shape and course of the CAF as well as of the surrounding structures. It may serve as a noninvasive diagnostic tool when planning a therapeutic strategy.
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Valente AM, Lock JE, Gauvreau K, Rodriguez-Huertas E, Joyce C, Armsby L, Bacha EA, Landzberg MJ. Predictors of Long-Term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae. Circ Cardiovasc Interv 2010; 3:134-9. [DOI: 10.1161/circinterventions.109.883884] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Significant morbidities, including angina, symptomatic heart failure, and myocardial infarction, have been reported after coronary artery fistula (CAF) closure; however, predictors that may be associated with adverse outcomes have not been established. The goal of this investigation is to describe the long-term outcomes witnessed in patients with either treated or untreated CAF at our institution and to investigate whether certain features predicted adverse outcomes.
Methods and Results—
The records and angiograms of patients with CAF who underwent a diagnostic cardiac catheterization at Children’s Hospital Boston from 1959 through 2008 were reviewed. Of 76 patients identified, 20% were associated with additional congenital heart disease. Forty-four underwent transcatheter closure, 20 underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Three patients who had initially undergone surgical closure had a second intervention, 1 underwent repeat surgery, and 2 underwent transcatheter closure. One patient who had undergone transcatheter closure underwent a second transcatheter closure for residual fistula. Major complications, including myocardial infarction, angina with coronary thrombosis, and symptomatic cardiomyopathy, occurred in 11 (15%) patients. The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus (
P
<0.001). Clinical predictors associated with adverse outcomes included older age at diagnosis (
P
<0.001), tobacco use (
P
=0.006), diabetes (
P
=0.05), systemic hypertension (
P
<0.001), and hyperlipidemia (
P
<0.001).
Conclusions—
Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction, and cardiomyopathy. CAF that drain into the coronary sinus are at particularly high-risk of long-term morbidities after closure, and strategies including long-term anticoagulation should be considered.
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Affiliation(s)
- Anne Marie Valente
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - James E. Lock
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Kimberlee Gauvreau
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Elizabeth Rodriguez-Huertas
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Caitlyn Joyce
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Laurie Armsby
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Emile A. Bacha
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
| | - Michael J. Landzberg
- From the Department of Cardiology (A.M.V., J.E.L., K.G., E.R.H., C.J., M.J.L.), Department of Cardiothoracic Surgery (E.A.B.), Children’s Hospital Boston, Boston, Mass; Division of Cardiology (A.M.V., M.J.L.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (L.A.), Oregon Health and Science University, Portland, Ore
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Abdelmoneim SS, Mookadam F, Moustafa S, Zehr KJ, Mookadam M, Maalouf JF, Holmes DR. Coronary artery fistula: single-center experience spanning 17 years. J Interv Cardiol 2007; 20:265-74. [PMID: 17680856 DOI: 10.1111/j.1540-8183.2007.00267.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Coronary artery fistula (CAF) is an uncommon form of congenital heart disease. It is often diagnosed incidentally during angiograms. We have reported on clinical characteristics, diagnosis, and management of CAF. METHODS Retrospective review of a tertiary referral institution's database identified 30 patients with CAF between 1987 and 2004. Mean follow-up was 31.61 +/- 48.03 months. RESULTS Mean age was 60 +/- 12.7 years. Most common site of CAF origin was the left anterior descending artery (LAD) (14, 46.7%). The most common site of drainage was the main pulmonary artery (15, 50%). Therapeutic strategies were based on symptoms and shunt size. Conservative management was the option in 17 patients (56.7%) with small shunts and mild or no symptoms. Patients with moderate/severe symptoms and/or large shunts were treated with either percutaneous embolization (6, 20%) or surgical ligation (7, 23.3%). Four patients (13.3%) died during follow-up. No deaths were reported in the embolization group, two patients died of cancer in the conservative management group, and two patients died in the surgical group due to cardiac tamponade and cancer, respectively. CONCLUSIONS Origin of CAF was predominantly from the left system. Clinical presentations were variable depending on type, size of fistula, and the presence of other cardiac conditions. Management of CAF is still controversial and treatment of adult asymptomatic patients with nonsignificant shunting is still a matter of debate. Newer imaging modalities may enhance noninvasive diagnosis. A national registry is necessary for further insights into optimal treatment for large fistulae and the natural history of smaller fistulae.
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