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Song Y, Choi ES, Kim DH, Kwon BS, Park CS, Yun TJ. Surgical Management of Coronary Artery Fistulas in Children. J Chest Surg 2024; 57:79-86. [PMID: 38174894 DOI: 10.5090/jcs.23.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
Background This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. Methods We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1-25.6 years). Results The median age and body weight at repair were 3.1 years (range, 0-13.4 years) and 14.4 kg (range, 3.1-42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Conclusion Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.
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Affiliation(s)
- Youngkwan Song
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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2
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Wu S, Fares M, Zellers TM, Jyothinagaram M, Reddy SRV. Diagnosis and Management of Congenital Coronary Artery Fistulas in Infants and Children. Curr Cardiol Rep 2023; 25:1921-1932. [PMID: 38051412 DOI: 10.1007/s11886-023-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE OF REVIEW Coronary artery fistulas (CAFs) are rare coronary anomalies that most often occur as congenital malformations in children. Although most children with CAFs are asymptomatic at the time of diagnosis, some present with symptoms of congestive heart failure in the setting of large left-to-right shunts. Others may develop additional complications including coronary artery ectasia and coronary thrombosis. Surgical and transcatheter closure techniques have been previously described. This review presents the classifications of CAFs in children and the short and long-term outcomes of CAF closure in children in the reported literature. We also summarize previously-reported angiographic findings and post-treatment remodeling characteristics in pediatric patients. RECENT FINDINGS With advancements in cross-sectional imaging technologies, anatomic delineation of CAFs via these modalities has become crucial in procedural planning. Recent reports of surgical and transcatheter closure of CAFs in children have reported good procedural success and low rates of short-term morbidity and mortality. Distal-type CAFs have elevated risk for long-term sequelae post-closure compared to proximal-type CAFs. A recent report of a multi-institutional cohort also describes post-closure remodeling classifications which may predict long-term outcomes in these patients as well as guide individualized anticoagulation management. Invasive closure of significant CAFs via surgical or transcatheter techniques is feasible and safe in most children with good short and intermediate-term outcomes. However, close clinical and imaging follow-up is required to monitor for late complications even after successful closure. Antiplatelet and anticoagulation regimens remain important aspects of post-closure management, but the necessary intensity and duration of such therapy remains unknown.
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Affiliation(s)
- Stephan Wu
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
| | - Munes Fares
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Thomas M Zellers
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Maanya Jyothinagaram
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
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3
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Sharma V, Doig F, Maxwell R, Grout D, Saeed U, Wall D. Anomalous Right Coronary Artery Originating From the Pulmonary Artery (ARCAPA): A Rare Presentation in the Fifth Decade. World J Pediatr Congenit Heart Surg 2023; 14:241-243. [PMID: 36529891 DOI: 10.1177/21501351221141437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Presented is a case report of a 54-year-old male Jehovah's Witness diagnosed with an anomalous right coronary artery originating from the main pulmonary artery with the initial presentation with a history of episodic fatigue, chest pain, palpitation, and bodily weakness. The patient was managed with reimplantation of the anomalous coronary artery onto the ascending aorta.
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Affiliation(s)
- V Sharma
- Department of Cardiothoracic Surgery, 67567The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - F Doig
- Department of Cardiothoracic Surgery, 67567The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Ryan Maxwell
- Department of Cardiology, 67567The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - D Grout
- Department of Radiology, Mater Private 67472Hospital, Bundaberg, Queensland, Australia
| | - U Saeed
- Department of Radiology, Mater Private 67472Hospital, Bundaberg, Queensland, Australia
| | - D Wall
- Department of Cardiothoracic Surgery, 67567The Prince Charles Hospital, Brisbane, Queensland, Australia
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4
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Sharifkazemi M, Mohseni-Badalabadi R, Hosseinsabet A, Hajizeinali A. Case report: Multimodal imaging diagnosis of a giant coronary artery fistula: A report of two cases. Front Cardiovasc Med 2022; 9:986078. [PMID: 36386328 PMCID: PMC9644096 DOI: 10.3389/fcvm.2022.986078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Being a very rare cardiac disease, most cases of coronary artery fistula (CAF) are genetic. Complications such as coronary steal syndrome, myocardial infarction, heart failure, or tamponade can manifest following the abnormal communication that the fistula creates between the coronary arteries and cardiac chambers or major vessels and the subsequent shunt. Most CAFs are small and asymptomatic, making diagnosis difficult. In symptomatic patients, the initial diagnostic workup is generally made with chest radiography and electrocardiography. Other imaging modalities have also been suggested to improve diagnostic accuracy. Cardiac catheterization and coronary angiography are currently the gold standard for diagnosis and planning the intervention, as they can recognize the quantum of the shunt as well as complications of a fistulous track (e.g., aneurysm formation, thrombus, leak, and the number of openings to the receiving chamber/vessel); however, this invasive method may be associated with risk. Herein, we report two patients with giant CAFs, one from the left circumflex artery to the coronary sinus and the other to the superior vena cava. Moreover, we describe how multimodal imaging, including two- and three-dimensional transesophageal echocardiography, coronary cineangiography, coronary computed tomography angiography, and enhanced chest computed tomography, can facilitate diagnosis and estimate the disease course in such patients. We believe that using multimodal imaging cannot only help the initial diagnosis regarding the presence of a CAF and the accurate anatomical site of the fistula in the patient but can also help predict the disease course and choose the most suitable treatment modality. Therefore, we suggest multimodal imaging be done to diagnose patients suspected of CAF. However, invasive cineangiography should be necessarily followed, regardless of whether an intervention is planned or not.
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Affiliation(s)
- Mohammadbagher Sharifkazemi
- Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- *Correspondence: Mohammadbagher Sharifkazemi,
| | - Reza Mohseni-Badalabadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohammad Hajizeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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Pullela NK, Acharya D, Shanmugasundaram M, Acharya T, Ajmal M, Truong HT, Shetty R, Lotun KD. Transcatheter Closure of Complex Left Circumflex to Coronary Sinus Fistula. JACC Case Rep 2022; 4:559-563. [PMID: 35573853 PMCID: PMC9091539 DOI: 10.1016/j.jaccas.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
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6
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Gowda ST, Latson L, Sivakumar K, Hiremath G, Crystal M, Law M, Shahanavaz S, Asnes J, Veeram Reddy S, Kobayashi D, Alwi M, Ichida F, Hirono K, Tahara M, Takeda A, Minami T, Kutty S, Nugent AW, Forbes T, Prieto LR, Qureshi AM. Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry. Circ Cardiovasc Interv 2021; 14:e009750. [PMID: 34903033 DOI: 10.1161/circinterventions.120.009750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. METHODS A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. RESULTS Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01-1) and 4.2 kg (1.7-10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1-18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. CONCLUSIONS Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.
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Affiliation(s)
- Srinath T Gowda
- Department of Pediatrics, Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (S.T.G., A.M.Q.)
| | - Larry Latson
- Pediatric Cardiology, Joe DiMaggio Children's Hospital, Hollywood, FL (L.L.)
| | | | - Gurumurthy Hiremath
- Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis (G.H.)
| | - Matthew Crystal
- Pediatric Cardiology, Irving Medical Center, Columbia University, New York, NY (M.C.)
| | - Mark Law
- Pediatric Cardiology, Children's of Alabama, University of Alabama at Birmingham (M.L.)
| | | | - Jeremy Asnes
- Pediatric Cardiology, Yale New Haven Children's Hospital, CT (J.A.)
| | | | - Daisuke Kobayashi
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI (D.K., T.F.)
| | - Mazeni Alwi
- Pediatric Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (M.A.)
| | - Fukiko Ichida
- Department of Pediatrics, University of Toyoma, Japan (F.I., K.H.)
| | - Keiichi Hirono
- Department of Pediatrics, University of Toyoma, Japan (F.I., K.H.)
| | - Masahiro Tahara
- Department of Pediatrics, Tsuchiya General Hospital, Hiroshima, Japan (M.T.)
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan (A.T.)
| | - Takaomi Minami
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan (T.M.)
| | - Shelby Kutty
- Pediatric Cardiology, Helen B. Taussig Heart Center, The Johns Hopkins Hospital, Baltimore, MD (S.K.)
| | - Alan W Nugent
- Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL (A.W.N.)
| | - Thomas Forbes
- Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI (D.K., T.F.)
| | - Lourdes R Prieto
- Pediatric Cardiology, Nicklaus Children's Hospital, Miami, FL (L.R.P.)
| | - Athar M Qureshi
- Department of Pediatrics, Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (S.T.G., A.M.Q.)
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7
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Taskesen T, Osei K, Hamilton R, Ugwu J, Shivapour D, Tannenbaum M, Ghali M. Coronary Artery Fistulae in Adult: Two Decades of Experience in Clinical Presentation, Angiographic Feature, and Management. Int J Angiol 2021; 30:277-284. [PMID: 34853575 DOI: 10.1055/s-0041-1727134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Coronary artery fistula (CAF) in adults is a rare but significant coronary artery anomaly. Main data on that rare disease were mostly obtained from case reports and small studies. In presented study, we share our two-decade experience on the clinical and angiographic characteristics of CAF. The data were collected retrospectively by analyzing the angiographic data between January 1, 2000 and December 31, 2019. Demographic data, clinical data, laboratory, and cardiac catheterization reports were reviewed. CAFs were found in 40 patients (0.06%). There were 22 male (55%) patients. The mean age was 61.2 years. Twenty-nine patients (72.5%) had small, 4 patients (10%) had medium, and 7 patients (17.5%) had large CAFs. The majority of study population had solitary CAF ( n = 31, 77.5%). The pulmonary artery is the major side of fistula drainage ( n = 20, 50%). The study population was divided into two groups as follow: group 1-small CAFs 29 (72.5%), group 2-medium and large CAF (MLCAF) 11 (27.5%). Patients with MLCAFs had more atrial fibrillation, abnormal coronary morphology, and multiple fistulae. In patients with hemodynamically significant CAFs, 7 (17.5%) patients had surgical ligation and 3 (7.5%) patients had transcutaneous closure. Three patients died during mean follow-up period of 5 years. The incidence and the pattern of CAFs in our study were similar to previous studies. Clinical course of small fistulae was benign. Symptomatic MLCAFs need to be treated by transcatheter or surgical way and should be individualized per patient.
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Affiliation(s)
- Tuncay Taskesen
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Kofi Osei
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Russell Hamilton
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Justin Ugwu
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Daniel Shivapour
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Mark Tannenbaum
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Magdi Ghali
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
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8
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Abstract
Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
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9
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Firouzi A, Alemzadeh-Ansari MJ, Mohebbi B, Khajali Z, Khalilipur E, Baay M, Bayatian A, Taherian M, Khosropour A, Hosseini Z. Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach. Curr Probl Cardiol 2021; 47:101010. [PMID: 34599986 DOI: 10.1016/j.cpcardiol.2021.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
Coronary artery fistulas (CAFs) are accounted as the most congenital coronary anomalies. As their natural course is progressive dilatation of the feeder arteries and the fistula tract, so, catastrophic complications are frequently illustrated by aging. Even in those with asymptomatic small fistulas, close follow-up is mandatory to prevent subsequent sequelas. In patients with medium or large-sized fistulas, irrespective of symptoms, closure (either by surgical ligation or transcatheter closure) is recommended. In the current era of advances in the equipment and devices and also innovations in percutaneous closure techniques and preprocedural imaging, TCC is now regarded as the preferred strategy for CAF closure except in some high-risk cases. So, by appropriate case selection modalities, pre-procedural planning, and determining the closure techniques, recent small case-series studies have been reported good final angiographic and clinical results by TCC. In this article, we have introduced several transcatheter closure techniques by details; also, we have recommended more multi-center trials with long-term clinical follow-up to address the best treatment options in these patients.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khosropour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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10
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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11
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Adam EL, Generoso G, Bittencourt MS. Anomalous Coronary Arteries: When to Follow-up, Risk Stratify, and Plan Intervention. Curr Cardiol Rep 2021; 23:102. [PMID: 34196813 DOI: 10.1007/s11886-021-01535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronary artery anomalies are a diverse group of entities, ranging from benign variations of normal anatomy to life-threatening conditions. There is, however, no universal consensus in their classification, risk stratification, and management. The aim of this review is to develop a straightforward clinical approach for the assessment and care of patients with anomalous coronary arteries. RECENT FINDINGS Autopsy series and population screening studies have recently provided useful clinical data on the prevalence and outcomes of coronary anomalies. Also, findings on coronary computed tomography angiography, magnetic resonance imaging, and invasive angiography, enriched with fractional flow reserve and intravascular ultrasound, have allowed identification of several high-risk features associated with specific coronary anomalies. Management of patients with anomalous coronary arteries requires an individualized approach based on clinical, physiological, and anatomic features. High-quality studies are paramount for further development of this fascinating field.
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Affiliation(s)
| | - Giuliano Generoso
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- DASA, Sao Paulo, Brazil.
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12
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Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure. JACC Cardiovasc Interv 2021; 14:1393-1406. [PMID: 34238550 DOI: 10.1016/j.jcin.2021.02.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/20/2022]
Abstract
Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.
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13
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Siripornpitak S, Sriprachyakul A, Promphan W, Mokarapong P, Wanitkun S. Coronary artery changes in congenital coronary-cameral fistulas evaluated by computed tomographic angiography. Jpn J Radiol 2021; 39:1149-1158. [PMID: 34181176 DOI: 10.1007/s11604-021-01164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment. MATERIALS AND METHODS We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis. RESULTS Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up. CONCLUSIONS Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand. .,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Apichaya Sriprachyakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
| | - Worakan Promphan
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rangsit University, 420/8 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pirapat Mokarapong
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suthep Wanitkun
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Division of Cardiology, Department of Pediatrics, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
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14
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El Nihum LI, Thakkar AN, Chinnadurai P, Lin CH. Successful coil embolization of a large right coronary artery-coronary sinus fistula causing a significant left-to-right shunt: a case report. Eur Heart J Case Rep 2021; 5:ytab121. [PMID: 34124558 PMCID: PMC8189309 DOI: 10.1093/ehjcr/ytab121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 03/12/2021] [Indexed: 11/20/2022]
Abstract
Background This case reviews a challenging but successful transcatheter coil embolization of a large congenital coronary artery fistula (CAF) causing a significant left-to-right shunt. Case summary A 51-year-old female with no significant prior history presented with symptoms of dyspnoea and chest discomfort. Extensive evaluation revealed a large CAF between a tortuous right coronary artery (RCA) and the coronary sinus (CS) composed of three aneurysmal pseudochambers. Closure of the RCA-CS fistula was attempted through coil deployment into the fistula neck. However, due to the brisk flow through the fistula, both coils embolized into the fistula sac. An alternative location was subsequently identified on three-dimensional rendering of a computed tomography angiography scan, which revealed a sharp bend in the RCA prior to the fistula neck and distal to the posterior descending artery (PDA) takeoff. Repeat attempt at embolization was accomplished using a telescoping system to reach and occlude the targeted bend. The coil mass remained stable and angiography demonstrated reduced flow through the fistula and preserved patency of the PDA. The decreased residual flow through the fistula secondary to the initial embolization attempt likely aided the successful deployment of coils in the second and final attempt. At 1 year, the patient was doing well with resolution of her symptoms and no clinical symptoms of coronary ischaemia. Discussion We suggest that an initial unsuccessful attempt at transcatheter embolization of a CAF should not preclude subsequent attempts for closure when there exists an appropriate indication.
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Affiliation(s)
| | - Akanksha N Thakkar
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - C Huie Lin
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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15
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Medranda GA, Lance S, Waksman R, Bernardo NL. Colossal left main to right atrium fistula ligation complicated by left circumflex STEMI. Catheter Cardiovasc Interv 2021; 97:1218-1220. [PMID: 33068334 DOI: 10.1002/ccd.29333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/09/2022]
Abstract
Congenital left main (LM) coronary artery to right atrium fistulas with progression to aneurysm development are rare. Most patients remain asymptomatic, but for those with progressive symptoms, intervention is required. However, there are potential life-threatening complications associated with surgical intervention. We present a case of an extremely rare markedly aneurysmal LM to right atrial fistula treated with surgical ligation complicated by inferolateral ST-elevation myocardial infarction several days post-operatively treated successfully using mechanical aspiration thrombectomy, a stent-retriever, balloon angioplasty, and subsequent intravascular ultrasound-guided percutaneous coronary intervention with drug-eluting stent.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Shannon Lance
- Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
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16
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Shah L, Kundapur D, Nosib S. Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome! BMJ Case Rep 2021; 14:e242425. [PMID: 33762294 PMCID: PMC7993208 DOI: 10.1136/bcr-2021-242425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to 'coronary steal syndrome'. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.
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Affiliation(s)
- Love Shah
- Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deeksha Kundapur
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shravan Nosib
- Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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17
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Melillo F, Maranta F, Alfieri O, Cianflone D. Cardiac arrest due to acute thrombosis after surgical closure of coronary fistula: the role of anticoagulation. Gen Thorac Cardiovasc Surg 2021; 69:1008-1011. [PMID: 33591482 DOI: 10.1007/s11748-021-01603-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
Described herein the case of a 47-year-old woman who underwent surgical closure of a large fistula between the right coronary artery (RCA) and the superior vena cava with subsequent thrombosis of the ectatic RCA determining myocardial infarction and cardiac arrest. After resuscitation, rheolitic thrombectomy with AngioJet device was performed and anticoagulant treatment was started in addition to antiplatelet therapy. The type of antithrombotic therapy after coronary fistula closure is still debated but long-term anticoagulation should be considered in high-risk cases.
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Affiliation(s)
- Francesco Melillo
- San Raffaele Scientific Institute, Via Olgettina 48/60, 20132, Milan, Italy
| | - Francesco Maranta
- San Raffaele Scientific Institute, Via Olgettina 48/60, 20132, Milan, Italy.
| | - Ottavio Alfieri
- San Raffaele Scientific Institute, Via Olgettina 48/60, 20132, Milan, Italy
| | - Domenico Cianflone
- San Raffaele Scientific Institute, Via Olgettina 48/60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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18
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Tang L, Wang ZJ, Tang JJ, Fang ZF, Hu XQ, Tai S, Xing ZH, Shen XQ, Zhao YS, Zhou SH. Transcatheter Closure of Large Coronary-Cameral Fistulas Using the Patent Ductus Arteriosus Occluder or Amplatzer Vascular Plugs. Int Heart J 2020; 61:1220-1228. [PMID: 33191343 DOI: 10.1536/ihj.20-169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transcatheter closure (TCC) has emerged as the first-line treatment for coronary artery fistulas. However, limited data exist regarding the long-term outcomes and technical aspects of this procedure. We aimed to report the long-term outcomes and technical aspects of TCC of large coronary-cameral fistulas (CCFs).All patients with large CCFs who underwent attempted TCC using the patent ductus arteriosus (PDA) occluder or Amplatzer vascular plug (AVP), from June 2002 to December 2017, were retrospectively reviewed. A total of 23 patients with large CCFs underwent attempted TCC using the PDA occluder or AVP. Most CCFs originated from the right coronary artery and drained predominantly into the right heart chamber. Procedural success was achieved in 21 (91.3%) patients. Devices were deployed using the arteriovenous loop in 15, transarterial approach in 4, and arterio-artery loop approach in 2 patients. Procedural complications included coronary spasm in one and side branch occlusion in one patient. Among these 21 patients with successful device implantation, follow-up angiograms or computed tomography angiograms were obtained in 14 (66.7%) patients at a median of 11.0 (range, 9.8-16.3) months. Late complications included thrombosis of residual fistula segment without myocardial infarction (MI) in one, coronary thrombosis resulting in MI in one, and recanalization necessitating re-intervention in one patient. No death and device embolization occurred.TCC of large CCFs using the PDA occluder or AVP is an effective therapy in anatomically suitable candidates, with favorable long-term outcomes. Given that potentially hazardous complications may occur late after the procedure, long-term periodic evaluation is mandatory.
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Affiliation(s)
- Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhao-Jun Wang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Jian-Jun Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhen-Fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Xin-Qun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Shi Tai
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhen-Hua Xing
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Xiang-Qian Shen
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Yan-Shu Zhao
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Sheng-Hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University
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19
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Wang X, Pang C, Liu X, Wang S, Zhang Z, Chen J, Zhuang J, Zhou C. Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical closure. BMC Cardiovasc Disord 2020; 20:484. [PMID: 33198628 PMCID: PMC7670810 DOI: 10.1186/s12872-020-01769-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Transcatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited. METHODS We retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups. RESULTS In total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up. CONCLUSIONS TCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.
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Affiliation(s)
- Xiaoyong Wang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Chengcheng Pang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Shushui Wang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Chengbin Zhou
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China.
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20
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Poretti G, Lo Rito M, Varrica A, Frigiola A. A case report of a coronary artery fistula to coronary sinus with giant aneurysm: risk does not end with repair. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33447712 PMCID: PMC7793215 DOI: 10.1093/ehjcr/ytaa297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 08/04/2020] [Indexed: 11/14/2022]
Abstract
Background Isolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08–0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left–right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication. Case summary We report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia. Discussion Management of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.
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Affiliation(s)
- Giulia Poretti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
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21
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Sayyouh M, Lee E, Bhave N, Kim K, Agarwal PP. Imaging and Management of Coronary Artery Anomalies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Coronary Artery Fistula. JACC Case Rep 2020; 2:1192-1195. [PMID: 34317446 PMCID: PMC8311697 DOI: 10.1016/j.jaccas.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 11/23/2022]
Abstract
Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a heart chamber resulting in left-to-right shunt. A large CAF was an unexpected cause of heart failure in a 58-year-old woman who underwent transcatheter closure of the CAF with improvement in symptoms but complicated by myocardial infarction. (Level of Difficulty: Beginner.)
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23
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Ahmed MF, Mubin A, Syed R, Mahmood AK, Sahni S. Multivessel Coronary Artery Fistula Presenting as Coronary Steal Syndrome Leading to Cardiac Arrest. Cureus 2020; 12:e8358. [PMID: 32617229 PMCID: PMC7325350 DOI: 10.7759/cureus.8358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The coronary steal phenomenon refers to myocardial ischemia caused by the diversion of blood away from normal myocardial circulation. A coronary artery fistula (CAF) is an abnormality of the coronary anatomy characterized by the aberrant termination of a coronary artery or its branches into cardiac chambers or great vessels. Although CAFs are often thought to be asymptomatic, fistulas that diverge a significant amount of blood flow and decrease the normal perfusion of myocardial tissue can cause ischemia and can present with acute coronary syndrome. We describe a unique case of a 70-year-old woman with no coronary artery disease (CAD) undergoing ventricular fibrillation and sudden cardiac arrest from myocardial ischemia secondary to coronary steal brought on by multivessel CAFs. This case was unique in that fistulas originating from the left anterior descending and from the circumflex artery draining into the left heart chambers are the least frequently observed. To our knowledge, only two other reports in the literature, demonstrating sudden cardiac arrest in patients with left anterior descending to left ventricle fistulas with no CAD, exist. The case presented, along with the literature reviewed, demonstrates that CAFs may be an important part of the differential diagnosis of symptoms of chest pain and myocardial ischemia, particularly in middle-aged adults with no history of coronary artery disease or related comorbidities.
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Affiliation(s)
- Muhammad F Ahmed
- Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, USA
| | - Anaam Mubin
- Internal Medicine, Saba University School of Medicine, The Bottom, NLD
| | - Rumman Syed
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Abdullah K Mahmood
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Sonu Sahni
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA.,Research Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, USA.,Primary Care, Touro College of Osteopathic Medicine, New York, USA
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24
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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Shah AH, Osten M, Benson L, Alnasser S, Bach Y, Meier L, Horlick E. Long‐term outcomes of percutaneous closure of coronary artery fistulae in the adult: A single‐center experience. Catheter Cardiovasc Interv 2019; 95:939-948. [DOI: 10.1002/ccd.28670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/23/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ashish H. Shah
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
- St. Boniface Hospital Winnipeg Manitoba Canada
| | - Mark Osten
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
| | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, Division of CardiologyThe University of Toronto School of Medicine Toronto Ontario Canada
| | - Sami Alnasser
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
| | - Yvonne Bach
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
| | - Lukas Meier
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
| | - Eric Horlick
- Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for AdultsToronto General Hospital, University Health Network Toronto Ontario Canada
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26
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Abstract
We present two patients, one 10 years old and another 43 years old, who both had successful transcatheter closure of left main coronary artery to right atrium fistulas. The older patient had a larger fistula as well as more symptoms and a complicated post-procedure course. Closure of medium or large coronary artery fistulas should be considered at younger ages to minimise future complications.
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27
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Kanzaki T, Numata S, Yamazaki S, Yaku H. Coronary Arteriovenous Fistula Draining Into Persistent Left Superior Vena Cava. Ann Thorac Surg 2019; 108:e265-e267. [PMID: 30878458 DOI: 10.1016/j.athoracsur.2019.01.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/13/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
Abstract
A 75-year-old woman was referred to our hospital for dyspnea and edema of the lower limbs. Computed tomography angiography revealed a dilated left coronary artery from the left main trunk to the left circumflex branch and a dilated fistula originating from the left circumflex branch and draining into the persistent left superior vena cava. Physical examination revealed pulmonary hypertension and congestive heart failure. We performed closure of the fistula and left main coronary artery orifice and coronary artery bypass grafting. Postoperative computed tomography angiography showed patency of all grafts and progression of thrombosis in the dilated abnormal vessels.
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Affiliation(s)
- Tomohito Kanzaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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28
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De Roeck F, Franssen C, De Wolf D, Haine S. Exercise-induced ventricular arrhythmia due to bilateral coronary to pulmonary artery fistulas. Catheter Cardiovasc Interv 2019; 94:112-116. [DOI: 10.1002/ccd.28108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Frederic De Roeck
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
| | | | - Daniel De Wolf
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Department of Pediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Steven Haine
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Cardiology, Department of Translational Pathophysiological Research; University of Antwerp; Wilrijk Belgium
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29
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Haller C. Commentary: The challenging management of coronary artery fistulas. J Thorac Cardiovasc Surg 2019; 157:e205-e206. [PMID: 30638618 DOI: 10.1016/j.jtcvs.2018.11.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph Haller
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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30
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Baskar S, Hirsch R, Powell AW, Tinker D, Kimball TR. Rare Cause for a Continuous Murmur: Large Left Coronary Artery to Coronary Sinus Fistula. World J Pediatr Congenit Heart Surg 2018; 9:705-707. [DOI: 10.1177/2150135118790948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shankar Baskar
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Russel Hirsch
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Adam W. Powell
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Devin Tinker
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas R. Kimball
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Li YF, Zhang ZW, Wang SS, Xie ZF, Zhang X, Li YF. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center. Chin Med J (Engl) 2018; 130:1919-1925. [PMID: 28776543 PMCID: PMC5555125 DOI: 10.4103/0366-6999.211894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center. Methods: Medical records of pediatric patients (<18 years old) who underwent transcatheter closure of CCAF with a giant CAA between April 2007 and September 2016 at Guangdong Cardiovascular Institute (Guangdong, China) were reviewed. Results: Twelve patients (median age, 6.1 years; range, 1.9–11.0 years) underwent successful transcatheter closure procedures. One patient underwent closure at both the entry and exit points of the CAA, three patients underwent closure at the exit point of the CAA, and eight patients underwent closure at the entry point of the CAA. After a mean follow-up of 7.2 years (range, 0.5–9.8 years), one patient (with closure at the exit point of the CAA) underwent transcatheter re-intervention because of a significant residual shunt. She eventually underwent a surgical procedure due to aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients. Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications.
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Affiliation(s)
- Yi-Fan Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Zhi-Wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Shu-Shui Wang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Zhao-Feng Xie
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Xu Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Yu-Fen Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
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Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics 2018; 38:688-703. [DOI: 10.1148/rg.2018170158] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gabin Yun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Tae Hyun Nam
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Eun Ju Chun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
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Abstract
PURPOSE OF REVIEW There is a broad spectrum of coronary artery anomalies that cardiologists may encounter either incidentally or during evaluation for cardiac symptoms. These anomalies include anomalous coronary arteries arising from the opposite sinus of Valsalva (ACAOS), coronary fistulae, and coronary artery aneurysms. This manuscript outlines the unique features, diagnostic characteristics, and treatment considerations for these lesions. RECENT FINDINGS Intravenous ultrasound (IVUS), computed tomographic angiography (CTA), and magnetic resonance imaging (MRI) are becoming more sophisticated and will be increasingly used to facilitate the optimal treatment approach for coronary anomalies. There are a wide variety of coronary artery anomalies and their clinical ramifications range from benign to potentially fatal. Coronary anomalies often have complex anatomy and require advanced imaging modalities for comprehensive characterization. Due to the heterogeneity in lesion characteristics and outcomes, physicians should consider clinical and imaging features to create individualized management plans, along with referral to adult congenital heart disease centers.
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Affiliation(s)
- Ajar Kochar
- Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
- , 2400 Pratt Street, Durham, NC, 27705, USA.
| | - Todd Kiefer
- Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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Kannan A, Lee J, Saleh L, Kanakadandi U, Rigatelli G, Lee K, Kasprzak J, Palacios I. How should I treat a coronary artery to pulmonary artery fistula at an acute stent thrombosis site? EUROINTERVENTION 2017; 13:1367-1372. [DOI: 10.4244/eij-d-16-00903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Carminati M, Giugno L, Chessa M, Butera G, Piazza L, Bussadori C. Coronary-cameral fistulas: indications and methods for closure. EUROINTERVENTION 2017; 12 Suppl X:X28-X30. [PMID: 27174108 DOI: 10.4244/eijv12sxa6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size and the best position for deployment to achieve complete occlusion of the fistula without compromising the flow in coronary side branches.
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Affiliation(s)
- Mario Carminati
- Pediatric and Adult Congenital Cardiology - Policlinico San Donato IRCCS, Milan, Italy
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36
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Agarwal PP, Dennie C, Pena E, Nguyen E, LaBounty T, Yang B, Patel S. Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging Appearances. Radiographics 2017; 37:740-757. [PMID: 28388272 DOI: 10.1148/rg.2017160124] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary artery anomalies constitute a diverse group of abnormalities, ranging from anatomic variants to those having hemodynamic consequences. This review focuses on major anomalies that have clinical implications requiring treatment, including anomalous origin of the coronary artery from the opposite sinus with interarterial course specifically with an intramural course, coronary artery origin from the pulmonary artery, and coronary artery fistula. Comprehensive imaging evaluation is necessary to precisely delineate the anatomy as well as pathophysiologic aspects of the anomaly before determining treatment options for a specific patient. Coronary computed tomographic angiography provides elegant depiction of coronary arterial anatomy and the relationship of the vessel to the adjacent structures, with the ability to perform three-dimensional reconstructions. Magnetic resonance (MR) imaging is emerging as an alternative noninvasive imaging strategy, particularly in young individuals, due to the lack of ionizing radiation and avoidance of iodinated contrast agents. This review describes the roles and recent technical advancements in computed tomography and MR imaging pertinent to coronary artery imaging. Additionally, this article will familiarize readers with the cross-sectional imaging appearance of clinically relevant coronary anomalies, hemodynamic considerations, and complex decision making. The different management strategies used for these anomalies, such as coronary unroofing, reimplantation, bypass grafting, Takeuchi repair, and surgical and interventional closure of fistulas, as well as specific posttreatment complications, are also discussed. ©RSNA, 2017.
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Affiliation(s)
- Prachi P Agarwal
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Carole Dennie
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elena Pena
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elsie Nguyen
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Troy LaBounty
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Bo Yang
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Smita Patel
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
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Unzué L, García E, Díaz-Antón B, Fernández-Portales J, Teijeiro R, Rodríguez-Del-Río M. Percutaneous closure of a giant coronary artery fistula after surgical pericardiectomy. Review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:384-389. [PMID: 28320605 DOI: 10.1016/j.carrev.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/15/2022]
Abstract
Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.
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Affiliation(s)
- Leire Unzué
- Interventional Cardiology, Hospital Universitario Madrid Montepríncipe, Madrid, Spain.
| | - Eulogio García
- Interventional Cardiology, Hospital Universitario Madrid Montepríncipe, Madrid, Spain
| | - Belén Díaz-Antón
- Cardiac Image Unit, Hospital Universitario Madrid Montepríncipe, Madrid, Spain
| | | | - Rodrigo Teijeiro
- Interventional Cardiology, Hospital Universitario Madrid Montepríncipe, Madrid, Spain
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Pediatric coronary artery fistula: echocardiographic case reports and literature review of treatment strategy. SPRINGERPLUS 2016; 5:1583. [PMID: 27652156 PMCID: PMC5025422 DOI: 10.1186/s40064-016-3276-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022]
Abstract
Background Coronary artery fistula (CAF) is a rare cardiac anomaly. Application of transthoracic echocardiography (TTE) is not fully illustrated in pediatric period. Meanwhile, the treatment strategy of CAF is still a controversial issue. Case presentation Five cases of CAF with different types were presented. We also retrospectively reviewed 32 records of CAF in our institution from May 2001 to January 2015, including cardiac murmurs, symptoms, TTE diagnoses, complications, other anomalies, treatment and outcome. We summarized the most acceptable treatment strategy for pediatric patients. 71.9 % of all (23/32) had murmurs, 15.6 % of all (5/32) had symptoms. 24 patients received surgery or other imaging examination after TTE. 87.5 % of all (21/24) were correctly and accurately diagnosed by echocardiography, including pointing out the origin and outlet of CAF and complication. During the followup of all 32 patients, there was no spontaneous closure, heart failure, infective endocarditis or death case. Conclusions TTE is a useful method that should be considered in the investigation and follow up of pediatric coronary artery fistula. The treatment strategy for pediatric patients should be individuation.
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Anagnostopoulos PV. A large international single-center case-series of coronary artery fistulas in children: When high clinical research standards adopted globally create exciting opportunities for the future. J Thorac Cardiovasc Surg 2016; 152:1131-2. [PMID: 27342732 DOI: 10.1016/j.jtcvs.2016.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Petros V Anagnostopoulos
- Division of Pediatric Cardiothoracic Surgery, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison, Wis.
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40
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Morawiec B, Muller O, Khatchatourov G, Goy JJ, Qureshi SA, Silaschi M, Wendler O. How should I treat a coronary artery fistula complicated with myocarditis - PCI or surgery? EUROINTERVENTION 2016; 12:e291-4. [PMID: 27290690 DOI: 10.4244/eijv12i2a45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Beata Morawiec
- Department of Cardiology, University Hospital, Lausanne, Switzerland
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Abstract
OBJECTIVES The aim of this study was to describe the clinical characteristics, progression, treatment, and outcomes in isolated coronary artery fistula cases diagnosed prenatally. METHODS We carried out a retrospective review of babies diagnosed prenatally with coronary artery fistulas between January, 2000 and December, 2013; five fetuses were included. Echocardiographic features and measurements were noted during pregnancy and after birth. Treatment and outcome were noted. RESULTS Gestational age at initial diagnosis was between 19 and 22 weeks; four coronary artery fistulas originated from the right and one from the left circumflex coronary artery. Drainage was into the right atrium in four cases and into the left ventricle in one case. There was cardiomegaly in two cases at the initial scan. The size of the fistulas increased during pregnancy in all except one. All prenatal diagnoses were confirmed postnatally. Among all, two patients developed congestive cardiac failure soon after birth and required transcatheter closure of the coronary artery fistula, 5 and 17 days after birth, respectively; three patients remained asymptomatic, and all of them showed progressive dilation of the feeding artery and had closure of the fistula at 20 months, 4 years, and 7 years of age, respectively. During the follow-up period, which ranged 2-14 years, all the patients were alive and well. CONCLUSIONS Coronary artery fistulas can be diagnosed accurately during fetal life. Some babies may develop congestive cardiac failure soon after birth requiring early treatment. Those treated conservatively should be kept under review as intervention may be required later.
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Al-Turki MA, Patton D, Crean AM, Horlick E, Dhillon R, Johri AM. Spontaneous Thrombosis of a Left Circumflex Artery Fistula Draining Into the Coronary Sinus. World J Pediatr Congenit Heart Surg 2016; 6:640-2. [PMID: 26467878 DOI: 10.1177/2150135115577432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 28-year-old woman was referred to our institution with sudden onset chest pain at rest. Electrocardiography revealed an inferoposterior ST-segment elevation myocardial infraction. The patient proceeded to cardiac catheterization, which revealed a large ectatic left circumflex coronary artery with an apparent fistula connecting it to the coronary sinus. Follow-up angiography revealed that the fistula was no longer patent, spontaneously thrombosed, and resolved without requiring surgery.
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Affiliation(s)
- Mohammad A Al-Turki
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Daniel Patton
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Andrew M Crean
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Eric Horlick
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Rob Dhillon
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Zhang W, Hu R, Zhang L, Zhu H, Zhang H. Outcomes of surgical repair of pediatric coronary artery fistulas. J Thorac Cardiovasc Surg 2016; 152:1123-1130.e1. [PMID: 27245418 DOI: 10.1016/j.jtcvs.2016.04.093] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/30/2016] [Accepted: 04/30/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Isolated congenital coronary artery fistula is a rare condition, and the surgical experience for treating this condition is limited. METHODS This was a retrospective review of 47 patients who underwent surgical repair of isolated congenital coronary artery fistula from January 2001 to March 2015. RESULTS All but 1 patient presented with no symptoms. The median age at operation was 3.9 years (range, 0.4-15.2 years), and the median weight was 15.2 kg (range, 6.3-77.0 kg). Right coronary artery to right ventricle fistula was the most common pattern, which was present in 16 patients. Epicardial ligation without cardiopulmonary bypass was used to treat 4 patients, whereas cardiopulmonary bypass was used in the remaining 43 patients. Surgical techniques included transcoronary closure in 20 patients, transcameral or transpulmonary closure in 20 patients, a combination of both transcameral and transcoronary closure in 2 patients, and a conversion from transcameral closure to epicardial ligation in 1 patient. There were no deaths during our study period. Injury to the mitral valve occurred in 1 patient. Residual shunt was observed in 8 patients, 2 of which closed spontaneously during the follow-up. Extracardiac repair was associated with a higher risk of recanalization (P = .004). Freedom from recanalization was 89.4%, 85.1%, 83.0%, and 83.0% at discharge, 6 months, 1 year, and 5 years postsurgery, respectively. Two patients required transcatheter closure for residual shunts. CONCLUSIONS Surgical repair of isolated congenital coronary artery fistula in pediatric patients can be performed with low mortality and morbidity. Careful evaluation after surgery is necessary to monitor the occurrence of residual shunt.
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Affiliation(s)
- Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongbin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Small coronary artery fistulae in childhood: a 6-year experience of 31 cases in a tertiary paediatric cardiac centre. Cardiol Young 2016; 26:738-42. [PMID: 26169294 DOI: 10.1017/s1047951115001225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study describes the incidence and course of children with small coronary artery fistulae over a period of 6 years who presented at a paediatric tertiary-care centre. Materials and methods Age at diagnosis, mode of presentation, location (origin and drainage), and association with a cardiac defect were documented and analysed. All patients obtained an electrocardiogram, and older patients were further evaluated with an exercise treadmill test. RESULTS A total of 31 patients were diagnosed with coronary artery fistula via transthoracic echocardiogram and comprised 0.43% of our entire patient group. Mean age was 6.14 years (standard deviation 5.4); 16 patients (52%) had associated cardiac defects. In the remaining 15 patients, the coronary artery fistula was discovered incidentally during diagnostic work-up for heart murmur or chest pain. Among all, 26 patients (84%) had left-sided and five patients (16%) had right-sided coronary artery fistulae. All right coronary artery fistula patients had associated cardiac defects; this was true for 42% of the patients with left coronary artery fistulae. None of the patients required any intervention due to the fistula, and spontaneous closure occurred in 12 patients (39%). CONCLUSION Small coronary artery fistulae in children are frequently an incidental finding, and many will close spontaneously. Our data are supportive of a conservative, observant approach in asymptomatic patients with small coronary artery fistula in the paediatric population.
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45
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McElhinney DB. The archaeology of uncommon interventions: Articulating the rationale for transcatheter closure of congenital coronary artery fistulas in asymptomatic children. Catheter Cardiovasc Interv 2016; 87:419-20. [DOI: 10.1002/ccd.26435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Doff B. McElhinney
- Department of Cardiothoracic Surgery; Stanford University; Palo Alto California
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46
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Gulgun M, Slack M. Percutaneous closure of a coronary fistula with single Amplatzer Vascular Plug II in a five-month-old female: The youngest case report. Rev Port Cardiol 2016; 35:117.e1-3. [DOI: 10.1016/j.repc.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/20/2015] [Accepted: 10/16/2015] [Indexed: 11/26/2022] Open
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47
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Gulgun M, Slack M. Percutaneous closure of a coronary fistula with single Amplatzer Vascular Plug II in a five-month-old female: The youngest case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Partington SL, Valente AM, Landzberg M, Grant F, Di Carli MF, Dorbala S. Clinical applications of radionuclide imaging in the evaluation and management of patients with congenital heart disease. J Nucl Cardiol 2016; 23:45-63. [PMID: 26129940 DOI: 10.1007/s12350-015-0185-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/12/2015] [Indexed: 02/04/2023]
Abstract
Non-invasive testing of children with congenital heart disease (CHD) began in the 1950s with the introduction of radionuclide studies to assess shunt fractions, pulmonary blood flow, and ventricular contractile function. Echocardiography and cardiac magnetic resonance imaging have since replaced radionuclide imaging in many of these roles. Concurrently, percutaneous and surgical repairs of complex CHD evolved, creating new roles for radionuclide imaging. In this paper on applications of radionuclide imaging in CHD, we review the multiple mechanisms for myocardial ischemia in CHD. We critically compare optimal radionuclide imaging techniques to other imaging modalities for assessing ischemia in CHD. We present the current role of nuclear imaging for assessing viability and pulmonary blood flow. We highlight the value added by advances in dedicated cardiac SPECT scanners, novel reconstruction software, and cardiac PET in performing low-dose radionuclide imaging in CHD. Finally, we discuss the emerging clinical indications for radionuclide imaging in CHD including coronary flow reserve assessment and evaluation of cardiovascular prosthesis and device infections.
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Affiliation(s)
- Sara L Partington
- The Philadelphia Adult Congenital Heart Disease Program. A Joint Program of Penn Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anne Marie Valente
- Boston Adult Congenital Heart Disease and Pulmonary Hypertension program, A Joint Program of Brigham and Women's Hospital and the Boston Children's Hospital, Boston, MA, USA
| | - Michael Landzberg
- Boston Adult Congenital Heart Disease and Pulmonary Hypertension program, A Joint Program of Brigham and Women's Hospital and the Boston Children's Hospital, Boston, MA, USA
| | - Frederick Grant
- Division of Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA.
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Closure of Isolated Congenital Coronary Artery Fistula: Long-Term Outcomes and Rate of Re-intervention. Pediatr Cardiol 2015; 36:1728-34. [PMID: 26111747 DOI: 10.1007/s00246-015-1224-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
Long-term outcome after closure of isolated congenital coronary artery fistula (ICCAF) is poorly documented. To assess late outcome after ICCAF closure, a 1983-2013 retrospective study included all patients who attempted an ICCAF closure and whose follow-up was ≥1 year. ICCAF was diagnosed in 23 patients [median age 6.9 years (0.1-70.5 years), 13 children]. ICCAF was symptomatic in 12 patients (52.2 %). First intervention was either a transcatheter embolization (n = 19 patients, 82.6 %) or a surgical ligation (n = 4 patients, 17.4 %). After a follow-up of 9.0 years (2.8-33.5), neither death nor late ischemic event occurred but one patient was transplanted, because of postoperative myocardial infarction. Late ICCAF recanalization occurred in eight patients, leading to successful embolization of the shunt in all patients after a delay of 9.8 years (5.7-13.8 years) from the first intervention. Re-intervention occurred later in children (p = 0.0027), with a 50 and 37.5 % freedom from re-intervention in adults compared to a 100 and 89.0 % in children, respectively, at 1 and 6 years of follow-up. At last follow-up, coronary artery diameter had decreased from a mean z score of 12.0 ± 7.7 to a mean z score of 6.0 ± 6.0 (p = 0.002). Long-term outcome after ICCAF closure is excellent, with neither death nor late ischemic event, and a significant decrease in coronary artery diameter with time. Late follow-up is of paramount importance, as one-third of patients will require a re-intervention for late shunt recanalization.
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Mottin B, Baruteau A, Boudjemline Y, Piéchaud FJ, Godart F, Lusson JR, Hascoet S, Le Gloan L, Fresse KW, Guyomarch B, Bouzguenda I, Malekzadeh-Milani S, Petit J, Guérin P. Transcatheter closure of coronary artery fistulas in infants and children: A French multicenter study. Catheter Cardiovasc Interv 2015; 87:411-8. [DOI: 10.1002/ccd.26320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/22/2015] [Accepted: 10/12/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Benoît Mottin
- Institut Du Thorax, Centre Hospitalier Universitaire De Nantes; France
| | - Alban Baruteau
- Centre Médico-Chirurgical De Marie Lannelongue; Le Plessis Robinson France
| | - Younes Boudjemline
- Hôpital Necker Enfants Malades, Assistance Publique Des Hôpitaux De Paris; France
| | | | | | - Jean-René Lusson
- Centre Hospitalier Universitaire Gabriel Montpied; Clermont Ferrand France
| | - Sebastien Hascoet
- Centre Médico-Chirurgical De Marie Lannelongue; Le Plessis Robinson France
- Centre Hospitalier Universitaire De Toulouse; France
| | | | | | | | | | | | - Jerome Petit
- Centre Médico-Chirurgical De Marie Lannelongue; Le Plessis Robinson France
| | - Patrice Guérin
- Institut Du Thorax, Centre Hospitalier Universitaire De Nantes; France
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