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Mohammad Nijres B, Taqatqa AS, Mubayed L, Jutzy GJ, Abdulla RI, Diab KA, Nguyen HH, Muller BA, Sosnowski CR, Murphy JJ, Vettukattil J, Kaley VR, Marckini DN, Samuel BP, Abdelhady K, Awad S. Determination of the Frequency of Right and Left Internal Mammary Artery Embolization in Single Ventricle Patients: A Two-Center Study. Pediatr Cardiol 2018; 39:1657-1662. [PMID: 30105467 DOI: 10.1007/s00246-018-1946-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022]
Abstract
Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to evaluate the frequency and implications of internal mammary artery (IMA) embolization in the single ventricle (SV) population. A retrospective chart review was performed of SV patients who underwent cardiac catheterization before and after Fontan procedure between February 2007 and 2017. Data were collected from two tertiary care centers in the Midwest. Of the 304 SV patients, 62 (20.4%) underwent embolization of one or more IMAs, whereas 242 (79.6%) did not. The rate of embolization of IMA was 40.5% in one center and 14.5% in the second center. Among patients who received IMA embolization, left internal mammary artery (LIMA) embolization was seen in 6 (9.7%) patients. Majority of patients underwent either right internal mammary artery (RIMA) embolization (n = 25; 40.3%) or RIMA and LIMA embolization (n = 27; 43.5%). IMA embolization in SV patients is common. Embolizing IMAs early in life will likely eliminate a valuable graft option for coronary artery bypass grafting should it be required in the future care of these patients. Multi-center, prospective, nation-wide studies are warranted to examine coronary artery disease in the SV population and true frequency of IMA embolization. Delineation of which IMAs were embolized is a necessary in surgical and cardiac intervention national data, such as Society of Thoracic Surgeons (STS) database. All measures should be taken to preserve IMAs patency, if deemed feasible and safe.
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Affiliation(s)
- Bassel Mohammad Nijres
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA.
| | - Anas S Taqatqa
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Lamya Mubayed
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Gregory J Jutzy
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Ra-Id Abdulla
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Karim A Diab
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Hoang H Nguyen
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Brieann A Muller
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Cyndi R Sosnowski
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Joshua J Murphy
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Joseph Vettukattil
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Vishal R Kaley
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Darcy N Marckini
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Bennett P Samuel
- Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Khaled Abdelhady
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60612, USA
| | - Sawsan Awad
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
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Carvajal LF, Bretón CO, Zapata MM, Guzmán MI, Ruz MA, Donado JR, Díaz LH, Lince R, Franco G. Embolización de colaterales en niños con cardiopatías congénitas. Experiencia en un centro cardiovascular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Munawar M, Siswanto BB, Harimurti GM, Nguyen TN. Transcatheter closure of coronary artery fistula using Guglielmi detachable coil. J Geriatr Cardiol 2012; 9:11-6. [PMID: 22783318 PMCID: PMC3390105 DOI: 10.3724/sp.j.1263.2012.00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 01/26/2023] Open
Abstract
Background Coronary artery fistula (CAF) is a rare anomaly. Transcatheter CAF closure has been introduced using various materials, but only few data are available on the Guglielmi detachable coil (GDC). The advantage of using GDC for transcatheter CAF closure is more controllable, therefore much safer when compared to other coils. This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital. Methods & Results From 2002 to 2007, there were 10 patients with CAFs (age range: 28 to 56 year-old, 7 males) who underwent transcatheter CAF closure. There were a total of 19 CAFs which originated from right coronary (n = 5), left circumflex (n = 3), left anterior descending artery (n = 10) and left main trunk (n = 1). Median number of coil deployment for each fistula was 3 (range: 1 to 6). The pulmonary artery was the most common site of the distal communication of CAFs (n = 14), followed by right atrium (n = 3), left atrium (n = 1) and left ventricle (n = 1). Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs, significant reduction of the flow in 5 (26.3%), while 2 (10.5%) could not be closed due to small size. Nine (90%) patients underwent a repeated angiography within 3 to 8 months. Among 12 CAFs that were occluded immediately post-deployment, there were 2 CAFs with insignificant residual flow. Among 6 CAFs with significantly decreased flow immediately post-deployment, 2 were occluded totally in the follow-up angiography. In total, 12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow, which did not need any additional coil deployment. During a mean follow up of 4.3 ± 0.7 year, all patients remained symptom and complication free. Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.
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Said SA. Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience. World J Cardiol 2011; 3:267-77. [PMID: 21876777 PMCID: PMC3163242 DOI: 10.4330/wjc.v3.i8.267] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multi-slice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.
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Affiliation(s)
- Salah Am Said
- Salah AM Said, Department of Cardiology, Hospital Group Twente, Location Hengelo, 7555 DL Hengelo, The Netherlands
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Seltzer S, Aboulhosn J, Levi DS. Use of interlock fibered detachable coils for occlusion of collaterals, coronary artery fistulae, and patent ductus arteriosus. Catheter Cardiovasc Interv 2010; 74:770-6. [PMID: 19472358 DOI: 10.1002/ccd.22092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the utility of interlocking detachable coils (IDC) for transcatheter occlusion of vascular communications in congenital heart disease. BACKGROUND The IDC can be delivered in a retractable fashion through hydrophilic Renegade microcatheters. They incorporate thrombogenic synthetic fibers and cost less than comparable neurovascular coils. They are ideally suited for use in many forms of congenital heart disease. METHODS A retrospective review of all patients catheterized during the initial 18-month period of IDC availability at our institution was performed. Interlock coils were only used if traditional methods could not be used easily and safely. All congenital patients in whom IDC were used are described. RESULTS A total of 61 coils were deployed in 17 patients with various vessels not amenable to treatment with conventional coils. Coils were used in aortopulmonary collaterals (n = 7), veno-venous collaterals (n = 9), patent ductus arteriosus (n = 3), and coronary artery fistulae (CAF) (n = 2). Operators were able to control coils and withdraw into the catheter for repositioning without difficulty. Thirteen of 21 vessels demonstrated immediate occlusion. All late angiograms have demonstrated complete occlusion of all vessels, with one exception requiring reintervention. One coil migrated from a large CAF and was easily retrieved with a snare. No serious complications occurred. All patients had an uneventful postcatheterization course. CONCLUSIONS Transcatheter vascular coil embolization with IDCs can be performed safely and effectively in a variety of circumstances.
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Affiliation(s)
- Sharon Seltzer
- Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Brown MA, Balzer D, Lasala J. Multiple coronary artery fistulae treated with a single Amplatzer vascular plug: check the back door when the front is locked. Catheter Cardiovasc Interv 2009; 73:390-4. [PMID: 19133675 DOI: 10.1002/ccd.21860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Congenital coronary artery fistulae are rare anomalies, which can result in myocardial ischemia or infarction, congestive heart failure, fistula rupture, or death. In this report, the authors describe a 56-year-old woman with new onset chest pain and palpitations. Exercise myocardial perfusion imaging was significant for a reversible perfusion defect in the anterior left ventricular wall. Left and right heart catheterization demonstrated multiple fistulous communications between the right coronary and left anterior descending coronary arteries with the pulmonary artery. All fistulae drained into the pulmonary artery by a common ampulla. Closure was achieved via a percutaneous approach using a single Amplatzer vascular plug.
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Affiliation(s)
- Michael A Brown
- Temple University School of Medicine, 3401 N. Broad St., 945 PP, Philadelphia, PA 19140, USA.
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Williams RJ, Levi DS, Moore JW, Boechat MI. Radiographic appearance of pediatric cardiovascular transcatheter devices. Pediatr Radiol 2006; 36:1231-41; quiz 1332-3. [PMID: 16896694 DOI: 10.1007/s00247-006-0254-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 05/04/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The treatment of congenital heart disease has been revolutionized by the availability of transcatheter devices. These advances in interventional pediatric cardiology require that both treating physicians and radiologists develop a more thorough understanding of the appearance of these devices on chest radiographs. Furthermore, recognition of appropriate versus inappropriate placement of transcatheter devices is essential to the care of patients with congenital heart disease. Knowledge of the radiographic appearance of devices used by interventional pediatric cardiologists can allow a radiologist to make better clinical assessments and detect possible complications given a limited clinical history.
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Affiliation(s)
- Ryan J Williams
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
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