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Buzaev IV, Plechev VV, Khalikova G, Khabirova K, Nikolaeva IE, Onorato EM. Case Report: Coil Occlusion of Two Congenital Coronary Cameral Fistulas Connecting Right and Left Circumflex Arteries to the Right Ventricle: An Innovative Stent-Assisted Technique. Front Cardiovasc Med 2022; 8:769235. [PMID: 35155596 PMCID: PMC8828911 DOI: 10.3389/fcvm.2021.769235] [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: 09/01/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Coronary cameral fistulas (CCFs) are rare congenital malformations consisting of abnormal vascular connections between coronary arteries and cardiac chambers, often incidentally found during cardiac catheterizations. Case summary A 66-year-old female asymptomatic patient, without cardiovascular risk factors and a history of varicose veins lower extremities and coronavirus disease 2019 (COVID-19) pneumonia in December 2020, was diagnosed by coronary angiography with two large coronary cameral fistulas connecting the distal right coronary artery (RCA) and the distal left circumflex artery (LCx) to the right ventricle (RV). Additional imaging modalities such as two-dimensional transthoracic/transesophageal echocardiography and three-dimensional multidetector CT angiography were required to confirm the fistula's pathway (location, number, and size), which was difficult to delineate using selective coronary angiography alone. After heart team discussion, with the aim to reduce the risk of embolization, an innovative stent-assisted coil occlusion antegrade technique was used with optimal immediate results. Discussion Even though our otherwise asymptomatic patient was not the best suitable candidate for an interventional procedure (large vessels, multiple fistulas without distal narrowing, distal portion of the fistula not accessible with the closure device), the innovative stent-assisted fistula coil occlusion technique to stabilize the first coil and deploy safely the additional ones resulted to be key for successful and complete obliteration of the abnormal congenital vascular connections.
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Affiliation(s)
- Igor V. Buzaev
- Bashkir State Medical University, Scientific Center of the Russian Academy of Science, Ufa, Russia
| | | | | | | | | | - Eustaquio Maria Onorato
- Bashkir State Medical University, Scientific Center of the Russian Academy of Science, Ufa, Russia
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico University School of Milan, Milan, Italy
- *Correspondence: Eustaquio Maria Onorato ; orcid.org/0000-0002-6750-5682
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Bao Y, Xiong TY, Li X, Feng Y. Percutaneous closure of a fistula from the left circumflex coronary artery to the coronary sinus in an infant. J Int Med Res 2021; 49:3000605211021732. [PMID: 34111997 PMCID: PMC8202310 DOI: 10.1177/03000605211021732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Coronary artery fistula is an abnormal direct connection between the coronary artery and any of the four chambers of the heart or great vessels. A fistula from the left circumflex coronary artery to the coronary sinus is a relatively rare situation. We report a case of 12-month-old infant with coronary artery fistula from the left circumflex coronary artery to the coronary sinus that was identified incidentally. The N-terminal pro-brain natriuretic peptide level was elevated. Additionally, the proximal segment of the left circumflex coronary artery was dilated. On the basis of these findings, percutaneous closure of the fistula was performed with a vascular plug. This procedure achieved no residual flow and good hemodynamics were observed during follow-up.
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Affiliation(s)
- Yun Bao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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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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Le J, Deano RC, Raval AN. It hurts to swallow! Pseudoachalasia resulting from attempted transcatheter occlusion of a giant congenital coronary artery fistula. Catheter Cardiovasc Interv 2019; 94:980-983. [DOI: 10.1002/ccd.28539] [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: 07/30/2019] [Revised: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Jonathan Le
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Roderick C. Deano
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Amish N. Raval
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
- Department of Biomedical Engineering University of Wisconsin Madison Wisconsin
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Affiliation(s)
| | - Gary Randall Green
- Department of Cardiothoracic Surgery SUNY Upstate Medical University Syracuse New York
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Kubicki R, Stiller B, Hummel J, Höhn R, Fleck T, Grohmann J. Collateral closure in congenital heart defects with Amplatzer vascular plugs: single-center experience and a simplified delivery technique for exceptional cases. Heart Vessels 2018; 34:134-140. [PMID: 30043154 DOI: 10.1007/s00380-018-1232-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
The study describes our experience with Amplatzer Vascular Plugs (AVP2 and 4) and highlights a more refindes telescopic technique for AVP2 delivery. AVPs are well-established occlusion devices for vascular anomalies in congenital heart disease (CHD). The AVP2 is sometimes preferred to the AVP4 due to its shorter length, flat-profiled retention disks, and the availability of larger diameters, but its profile requires a larger inner lumen for safe delivery. The latter may actually hamper access to target lesions. This is a retrospective analysis of all CHD patients treated with the AVP2 and AVP4 between 12/2012 and 12/2015. Target vessels were characterized, measured, and the device-to-vessel diameter ratio calculated. A modified pigtail technique for AVP2 delivery was frequently used: a floppy wire was simply reinforced by the curved tip of a pigtail catheter (instead of the long sheath's dilator) to guide the required delivery sheath towards the desired landing zone. 59 patients with a median age and bodyweight of 3.0 years (range 0.1-75) and 13.8 kg (range 2.5-80) underwent the implantation of 106 plug-devices (30 AVP2, 76 AVP4) in 91 target vessels. Indications for their use were ductus arteriosus (19%), aortopulmonary (43%) as well as venovenous collaterals (34%) and other miscellaneous lesions (4%). The pigtail-supported AVP2 delivery in six patients proved very convenient. No complications occurred. AVPs are excellent devices for embolizing shunt vessels in CHD patients. Here, we describe a simplified telescoping technique for AVP2 delivery to enter curvy target lesions gently and efficiently.
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Affiliation(s)
- Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Johanna Hummel
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Rene Höhn
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany.
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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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Albeyoglu S, Aldag M, Ciloglu U, Sargin M, Oz TK, Kutlu H, Dagsali S. Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes. Braz J Cardiovasc Surg 2017; 32:15-21. [PMID: 28423125 PMCID: PMC5382904 DOI: 10.21470/1678-9741-2017-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/28/2016] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to describe the demographic, clinical and anatomic
characteristics of coronary arteriovenous fistulas in adult patients who
underwent open cardiac surgery and to review surgical management and
outcomes. Methods Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9
years) who underwent surgical treatment for coronary arteriovenous fistulas
were retrospectively included in this study. Coronary angiography, chest
X-ray, electrocardiography and transthoracic echocardiography were
preoperatively performed in all patients. Demographic and clinical data were
also collected. Postoperative courses of all patients were monitored and
postoperative complications were noted. Results A total of 25 coronary arteriovenous fistulas were detected in 21 patients;
the fistulas originated mainly from left anterior descending artery (n=9,
42.8%). Four (19.4%) patients had bilateral fistulas originating from both
left anterior descending and right coronary artery. The main drainage site
of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%).
Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4
(19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients
were symptomatic. Seventeen patients were operated on with and 4 without
cardiopulmonary bypass. There was no mortality. Three patients had
postoperative atrial fibrillation. One patient had pericardial effusion
causing cardiac tamponade who underwent reoperation. Conclusion The decision of surgical management should be made on the size and the
anatomical location of coronary arteriovenous fistulas and concomitant
cardiac comorbidities. Surgical closure with ligation of coronary
arteriovenous fistulas can be performed easily with on-pump or off-pump
coronary artery bypass grafting, even in asymptomatic patients to prevent
fistula related complications with very low risk of mortality and
morbidity.
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Affiliation(s)
- Sebnem Albeyoglu
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Aldag
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Ciloglu
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Sargin
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tugba Kemaloglu Oz
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hakan Kutlu
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sabri Dagsali
- Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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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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Lee SN, Lee J, Ji EY, Jang BH, Lee HH, Moon KW. Percutaneous Management of Coronary Artery-to-pulmonary Artery Fistula Using an Amplatzer Vascular Plug with the Trans-radial Approach. Intern Med 2016; 55:929-33. [PMID: 27086807 DOI: 10.2169/internalmedicine.55.5765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congenital coronary artery fistulas (CAFs) are rare and asymptomatic, although symptomatic CAFs should be treated with percutaneous intervention or surgery. A 62-year-old woman developed bilateral coronary-to-pulmonary artery fistulas resulting in exertional chest pain. We herein report the successful use of trans-catheter closure of a coronary artery-to-pulmonary artery fistula, which lead to the coronary steal phenomenon, using an Amplatzer vascular plug with the trans-radial approach. After the procedure, the patient remained asymptomatic.
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Affiliation(s)
- Su Nam Lee
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Korea
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Lopera JE. The Amplatzer Vascular Plug: Review of Evolution and Current Applications. Semin Intervent Radiol 2015; 32:356-69. [PMID: 26622098 DOI: 10.1055/s-0035-1564810] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Amplatzer Vascular Plug (AVP) was created for peripheral embolization as a modification of the family of Amplatz septal occluders used in the treatment of congenital heart malformations. The device has evolved over the years and multiple versions have been launched into the market. Each of the versions of the device has some important modifications in terms of the size of the introducer's system, number of layers, and resultant thrombogenicity. It is very important for the operator to become familiar with the unique features of the AVP, and to understand the advantages and limitations of each model in the AVP family to achieve an optimal embolic result. The purpose of this article is to review the evolution and current clinical applications of the AVP in the field of interventional radiology, with emphasis on the advantages and limitations of this device in comparison with other embolization agents.
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Affiliation(s)
- Jorge E Lopera
- Department of Radiology, UT Health Science Center at San Antonio, San Antonio, Texas
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Zhang ZG, Xu XD, Bai Y, Zhang XL, Tan HW, Zhu YF, Chen L, Li CY, Chen X, Zhao XX, Qin YW. Transcatheter closure of medium and large congenital coronary artery fistula using wire-maintaining technique. J Cardiol 2015; 66:509-13. [DOI: 10.1016/j.jjcc.2015.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/14/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited. Cardiol Young 2015; 25:670-80. [PMID: 24775405 DOI: 10.1017/s1047951114000614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. METHOD Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. RESULTS A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery. CONCLUSION Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless the distal-most exiting segment is the primary site of occlusion.
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Percutaneous closure of coronary artery fistula: long-term follow-up results. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:318-22. [PMID: 26677382 PMCID: PMC4679800 DOI: 10.5114/pwki.2015.55603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/12/2015] [Accepted: 04/07/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. Aim To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. Material and methods We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. Results There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. Conclusions Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.
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Rohit MK, Sinha AK, Kamana NK. Early experience on peripheral vascular application of the vascular plugs. Indian Heart J 2013; 65:536-45. [PMID: 24206877 DOI: 10.1016/j.ihj.2013.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/23/2013] [Accepted: 08/09/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transcatheter closure of various congenital and acquired vascular malformations with Amplatzer Vascular plugs I and II has been established. Here we present our experience with device closure. MATERIALS AND METHODS Between October 2006 and August 2012, nine (three males and six females) patients aged between 11 months and 62 years (mean age 19 years) underwent percutaneous device closure with AVP I and II vascular plugs for congenital and acquired arteriovenous malformation and cardiac diverticulum are presented here. RESULTS One case of coronary cameral fistula, four cases of pulmonary arteriovenous fistula, one case of large major aortopulmonary collaterals (in tetralogy of Fallot closed before intracardiac repair), one case of congenital cardiac diverticulum, one case of fistula between external carotid artery and internal jugular vein and one case of iatrogenic carotid jugular fistula were successfully closed with AVP I and II plugs. Overall in nine cases, 16 AVP I and II plugs were deployed to occlude feeding vessels and one cardiac diverticulum. The technical success rate was 100%. No major complications were observed. CONCLUSION Amplatzer vascular plugs can be used successfully for closure of various congenital and acquired vascular malformations with good result.
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Affiliation(s)
- Manoj Kumar Rohit
- Additional Professor, Department of Cardiology, Advanced Cardiac Center, PGIMER, Chandigarh 160012, India.
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Wiegand G, Sieverding L, Bocksch W, Hofbeck M. Transcatheter closure of abnormal vessels and arteriovenous fistulas with the Amplatzer vascular plug 4 in patients with congenital heart disease. Pediatr Cardiol 2013; 34:1668-73. [PMID: 23591802 DOI: 10.1007/s00246-013-0701-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
Although vascular plugs allow the interventional closure of medium-sized to large abnormal vessels, their application is limited by the need for long sheaths or large guiding catheters. The authors report their experience with the new Amplatzer vascular plug 4 (AVP 4), a self-expanding spindle-shaped occluder made of Nitinol wire mash, which can be placed through 4-Fr catheters with an internal diameter of 0.038 in. or larger. From October 2009 until June 2012, 14 AVP 4 devices were deployed in 12 patients (ages, 0.3-48.8 years). Nine patients had venovenous or arteriovenous collaterals in functional univentricular hearts. One patient had pulmonary atresia with a ventricular septal defect and major aortopulmonary collateral arteries, and one patient had a pulmonary arteriovenous fistula. One child had a large coronary artery fistula to the right atrium. The authors used AVP 4 devices with diameters of 4-8 mm. In all the patients, the AVP 4 was implanted successfully. No occluder dislocations and no complications related to the procedure occurred. Complete vessel occlusion was achieved in seven cases. In seven additional cases, a residual shunt was present at the end of the procedure while the patients were still fully heparinized. In 2 of 14 vessels, the decision was made to place additional devices to abolish residual shunting. According to the authors' experience, the AVP 4 allows safe and effective occlusion of medium-size and large abnormal vessels. It is also well suited for tortuous high-flow vessels such as coronary or pulmonary arteriovenous fistulas. In case of a suboptimal position, it is possible to reposition the occluder with ease. Further studies are needed to determine whether initial residual shunting in heparinized patients disappears during follow-up care. The AVP 4 represents a valuable new device for the interventional treatment of complex congenital vessel malformations.
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Affiliation(s)
- Gesa Wiegand
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany,
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Phasalkar M, Thakkar B, Poptani V. Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road. Catheter Cardiovasc Interv 2013; 82:150-4. [PMID: 23361942 DOI: 10.1002/ccd.24838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/06/2013] [Accepted: 01/21/2013] [Indexed: 11/06/2022]
Abstract
Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery.
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Affiliation(s)
- Manjunath Phasalkar
- Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Gujarat University, Asarwa, Ahmedabad, 380016, Gujarat, India
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Said SM, Burkhart HM, Schaff HV, Connolly HM, Phillips SD, Suri RM, Eidem B, Rihal CS, Dearani JA. Late outcome of repair of congenital coronary artery fistulas—a word of caution. J Thorac Cardiovasc Surg 2013; 145:455-60. [DOI: 10.1016/j.jtcvs.2012.11.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/16/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
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SCHNEIDER M, WIEBE W, HRAŠKA V, ZARTNER P. Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients. J Interv Cardiol 2013; 26:287-94. [DOI: 10.1111/j.1540-8183.2013.12015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. SCHNEIDER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - W. WIEBE
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - V. HRAŠKA
- Department of Cardiothoracic Surgery; German Pediatric Heart Center; Sankt Augustin; Germany
| | - P. ZARTNER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
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20
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Mangukia CV. Coronary artery fistula. Ann Thorac Surg 2012; 93:2084-92. [PMID: 22560322 DOI: 10.1016/j.athoracsur.2012.01.114] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/25/2012] [Accepted: 01/31/2012] [Indexed: 01/29/2023]
Abstract
Although coronary arterial fistula is rare, it is one of the most common among the coronary artery anomalies. Coronary arterial fistula most commonly affects the right side of the heart. It may occur isolated or along with congenital heart diseases. Angiography remains the best investigation for diagnosing the disease. Unless very large and hemodynamically significant, it is usually asymptomatic in younger patients. With increasing age, symptoms begin to appear, and the incidence of complication rises. Treatment by transcatheter or surgical closure gives the best results, provided this is performed early in the course of the disease. This review was prepared by searching the terms "coronary artery fistula," "coronary cameral fistula," "surgical management of coronary arterial fistula," "MDCT in coronary artery fistula," and "multiple coronary artery fistulae" in Google Scholar, PubMed, and PubMed Central and exploring the related articles shown on the side of page.
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21
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The Amplatzer Vascular Plug: A Review of the Device and its Clinical Applications. Cardiovasc Intervent Radiol 2012; 35:725-40. [DOI: 10.1007/s00270-012-0387-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/25/2012] [Indexed: 12/16/2022]
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22
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Jama A, Barsoum M, Bjarnason H, Holmes DR, Rihal CS. Percutaneous closure of congenital coronary artery fistulae: results and angiographic follow-up. JACC Cardiovasc Interv 2012; 4:814-21. [PMID: 21777892 DOI: 10.1016/j.jcin.2011.03.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 03/25/2011] [Accepted: 03/30/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to assess clinical and angiographic outcomes in a series of 29 patients who underwent transcatheter closure of coronary artery fistulae (CAF). BACKGROUND Transcatheter closure of CAF has become an alternative to surgical closure, but the reported experience is relatively limited. METHODS Medical records of all patients with CAF who underwent transcatheter closure at the Mayo Clinic, Rochester, Minnesota, between 1997 and 2010, were reviewed. Patients with other complex cardiac lesions and those requiring surgery were excluded. RESULTS Twenty-nine patients with CAF underwent 36 transcatheter closure procedures. The most were women (55%), and the median age at the time of transcatheter closure was 49 years. Twenty-three patients had a single CAF. The most common presenting symptom was chest pain (52%). Thirty devices were deployed antegrade into 1 or more arterial feeders, 3 using an arteriovenous wire loop and 3 retrograde at the fistulous connection. Successful closure occurred immediately in all patients with no residual flow in 89% and with trivial flow in 11%. Four complications occurred including 2 device migrations, 1 coronary spasm, and 1 coronary thrombosis. A follow-up angiogram was obtained in 18 (62%) patients with a median time to follow-up angiography of 1.5 years. Ten patients (56%) of the 18 patients with follow-up angiography had no recanalization of embolized vessel; 4 patients (22%) had trivial recanalization, and 4 patients (22%) had large recanalization. A repeat closure procedure was performed in all 4 patients of the latter. CONCLUSIONS Transcatheter closure of CAF is feasible and should be considered in carefully selected patients. Recanalization of the treated coronary fistulae can occur, so follow-up angiography or other imaging modality should be performed in these patients.
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Affiliation(s)
- Abdi Jama
- Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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23
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Kosutic J, Prijic S, Vujic A. Successful Closure of Large Congenital Coronary Fistula With an Amplatzer Vascular Plug: A Case Report and Review of the Literature. World J Pediatr Congenit Heart Surg 2011; 2:513-6. [DOI: 10.1177/2150135111404089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the case of a 3.5-year-old-girl with large coronary fistula that originated from the proximal left coronary artery and, after a tortuous distal course, drained into the right atrium. The narrowest fistula diameter was 6.7 mm. Fistula was successfully closed with a 12-mm Amplatzer vascular plug type 1 using a retrograde approach without creating an arteriovenous loop. Femoral artery damage that required thrombolytic (streptokinase) therapy was observed after the procedure. Retrograde approach does not require creation of an arteriovenous loop. However, potential benefits have to be considered in the light of potential peripheral artery damage and subsequent thrombolytic therapy.
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Affiliation(s)
- Jovan Kosutic
- Department of Pediatric Cardiology, Mother and Child Health Institute, Belgrade, Serbia
| | - Sergej Prijic
- Department of Pediatric Cardiology, Mother and Child Health Institute, Belgrade, Serbia
| | - Ana Vujic
- University Childrens Hospital, Kragujevac, Serbia
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24
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Zhang W, Kuang L, Chen J, Kang H, Wang Y, Chen R, Xiong K. Left coronary artery-to-right atrium fistula: an evaluation of MSCT angiography before and after transcatheter closure with a PDA occluder. Heart Lung Circ 2011; 20:368-71. [PMID: 21514217 DOI: 10.1016/j.hlc.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/21/2010] [Accepted: 01/10/2011] [Indexed: 11/19/2022]
Abstract
The MSCT manifestations of a left coronary artery-to-right atrium fistula before and after the transcatheter closure were reported. Before treatment, MSCT showed a dilated left coronary sinus and the dilated left main trunk, which coursed along the coronary sulcus to form the left circumflex artery, draining directly into the right atrium in the left middle part. The fistula was occluded with a PDA occluder. Four days after the occlusion, MSCT showed that the fistula was completely occluded and there was massive thrombosis in the central part and around the occluder. The thrombus was found even in the segment near to the start point of the oblique marginal artery.
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Affiliation(s)
- Weiguo Zhang
- Department of Radiology, Daping Hospital, The Third Military Medical University, No. 10, Changjiang Side Road, Daping, Chongqing 400042, China.
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25
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Harikrishnan S, Bimal F, Ajithkumar V, Bhat A, Krishnamoorthy KM, Sivasubramonian S, Titus T, Tharakan J. Percutaneous treatment of congenital coronary arteriovenous fistulas. J Interv Cardiol 2011; 24:208-15. [PMID: 21649734 DOI: 10.1111/j.1540-8183.2010.00621.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Congenital coronary arteriovenous fistulas (CAVF), although rare, can present as significant hemodynamic lesions necessitating intervention. METHODS AND RESULTS Six patients (two males) with congenital coronary arteriovenous fistulas (CAVF) underwent percutaneous transcatheter occlusion. The ages ranged from 4 years to 49 years (mean 20.1 years). The fistulas had their origins from the right coronary artery (two), the left anterior descending coronary artery (two), and the left circumflex coronary artery (two). One of the fistulas drained to the right ventricle, four drained to the right atrium, and the remaining one to the left ventricle (LV). The fistulas were closed using the arterial approach with Cook™ coils in two patients and with nitinol ductal occluders (NDOs) using the venous approach in four patients. One patient developed dissection of the wall of the fistula during attempted closure and had spontaneous occlusion of the fistula. Complete occlusion of the fistulas were achieved in all patients. Complications consisted of migration and embolization of the coils in one patient (later closed successfully with NDO) and myocardial infarction occurring two weeks following successful closure in another patient. At mean follow-up of 39.6 +/- 22.9 months, all patients were asymptomatic and echo-Doppler evaluation revealed no residual fistulae. CONCLUSIONS CAVF are very well amenable to percutaneous closure with acceptable morbidity and high success rates.
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Affiliation(s)
- Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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26
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De Santis A, Cifarelli A, Violini R. Transcatheter closure of coronary artery fistula using the new Amplatzer vascular plug and a telescoping catheter technique. J Cardiovasc Med (Hagerstown) 2010; 11:605-9. [PMID: 19680132 DOI: 10.2459/jcm.0b013e3283313504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coronary artery fistulas (CAFs) are rare congenital or acquired anomalies characterized by an abnormal communication between the coronary arteries and the cardiac chambers or great vessels. Most patients are asymptomatic during childhood but symptoms and complications have been reported with advancing age. Until recently, surgery was the routine mode of treatment for CAFs but, today transcatheter closure is recommended using a variety of devices, such as occlusion coils, vascular plugs, umbrella devices and covered stents. The case described here is of a 47-year-old woman with a large bilateral CAF draining into the pulmonary artery, successfully treated by implantation of two Amplatzer vascular plugs using a telescoping catheter technique.
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Affiliation(s)
- Antonella De Santis
- Interventional Cardiology, Department of Cardiovascular Medicine, S. Camillo Forlanini Hospital, Rome, Italy
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27
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Mordasini P, Szucs-Farkas Z, Do DD, Gralla J, Kettenbach J, Hoppe H. Use of a Latest-generation Vascular Plug for Peripheral Vascular Embolization with Use of a Diagnostic Catheter: Preliminary Clinical Experience. J Vasc Interv Radiol 2010; 21:1185-90. [DOI: 10.1016/j.jvir.2010.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/02/2010] [Accepted: 03/11/2010] [Indexed: 12/12/2022] Open
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28
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Zhu XY, Zhang DZ, Han XM, Cui CS, Sheng XT, Wang QG, Cha YM, Abhiram P, Rihal CS. Transcatheter closure of congenital coronary artery fistulae: immediate and long-term follow-up results. Clin Cardiol 2009; 32:506-12. [PMID: 19743489 DOI: 10.1002/clc.20650] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transcatheter closure of coronary artery fistulae (CAF) has emerged as an alternative to surgery, but there are no long-term outcome results. OBJECTIVE We report immediate and long-term results in 24 patients after transcatheter closure of congenital CAF. METHODS A total of 24 patients aged 5 to 56 years old with congenital CAF underwent attempted percutaneous transcatheter closure using various devices between November 1998 and August 2008. The immediate closure results and clinical follow-up were reviewed. RESULTS Of the 24 patients, 20 (83.3%) underwent successful transcatheter closure using various devices. An angiogram right after device deployment revealed complete occlusion in 15 patients (75%) and trivial- to mild- residual flow in 5 patients (25%). Four patients (20%) had transient ST-T wave changes after the procedure. The left ventricular end-diastolic volume decreased from 165+/-31.4 mm3 to 128.6+/-24.4 mm3 (P = 0.012) 24 hours after procedure, and the cardiothoracic ratio from 0.57+/-0.02 to 0.53+/-0.01 (P = 0.003). Follow-up was 100% complete and ranged from 3 months to 10 years. There were no early or late deaths. All patients were asymptomatic with complete closure of CAF except 1 patient (5%) who had a recurrence of shunt at 6-month follow-up, which was re-closed by percutaneous technique. CONCLUSION Transcatheter closure of CAF is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients.
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Affiliation(s)
- Xian-Yang Zhu
- Department of Congenital Heart Disease, Northern Hospital, Shenyang, People's Republic of China.
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29
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Schwartz M, Glatz AC, Rome JJ, Gillespie MJ. The amplatzer vascular plug and amplatzer vascular plug II for vascular occlusion procedures in 50 patients with congenital cardiovascular disease. Catheter Cardiovasc Interv 2009; 76:411-7. [PMID: 20552654 DOI: 10.1002/ccd.22370] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
MESH Headings
- Adolescent
- Adult
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/instrumentation
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Child
- Child, Preschool
- Collateral Circulation
- Ductus Arteriosus, Patent/therapy
- Embolization, Therapeutic/adverse effects
- Embolization, Therapeutic/instrumentation
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Humans
- Infant
- Infant, Newborn
- Middle Aged
- Philadelphia
- Prosthesis Design
- Retrospective Studies
- Septal Occluder Device
- Treatment Outcome
- Vascular Malformations/diagnosis
- Vascular Malformations/physiopathology
- Vascular Malformations/therapy
- Young Adult
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Affiliation(s)
- Matthew Schwartz
- The Children's Hospital of Philadelphia, Division of Cardiology, Philadelphia, PA, USA.
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30
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Liang CD, Ko SF, Lin YJ, Fang CY. Transcatheter closure of a left circumflex coronary artery fistula in two children using the Amplatzer vascular plug. Pediatr Cardiol 2009; 30:1172-5. [PMID: 19727925 DOI: 10.1007/s00246-009-9518-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 08/03/2009] [Indexed: 11/24/2022]
Abstract
A left circumflex coronary artery fistula (CAF) is a rare anomaly. This report describes two young children with progressive left coronary artery dilation due to left CAF demonstrated by serial echocardiography. Cardiac catheterization performed for both children confirmed the presence of a markedly tortuous and dilated left circumflex artery, with the CAF draining directly into the right ventricle. Transcatheter closure of the CAF using the Amplatzer vascular plug was successfully accomplished without any complications. A good outcome was achieved. The echocardiography at the 12- and 18-month follow-up visits showed reversion of the coronary artery to normal size.
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Affiliation(s)
- Chi-Di Liang
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao Sung Hsiang, Kaohsiung County, Taiwan.
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31
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Delfs KC, Hawkins JF, Hogan DF. Treatment of acute epistaxis secondary to guttural pouch mycosis with transarterial nitinol vascular occlusion plugs in three equids. J Am Vet Med Assoc 2009; 235:189-93. [DOI: 10.2460/javma.235.2.189] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Lee ML, Chen M. Diagnosis and management of congenital coronary arteriovenous fistula in the pediatric patients presenting congestive heart failure and myocardial ischemia. Yonsei Med J 2009; 50:95-104. [PMID: 19259355 PMCID: PMC2649861 DOI: 10.3349/ymj.2009.50.1.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 03/06/2008] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Four pediatric patients with congenital coronary arteriovenous fistula (CAVF) were reported to remind pediatric practitioners and cardiologists of its diagnosis and management. MATERIALS AND METHODS Four pediatric patients with congenital CAVF from June 1999 to November 2007 were included in this retrospective study. Study modalities included reviews of patients' profiles of clinical features, chest radiograph, Doppler echocardiography, cardiac catheterization with angiography, myocardial perfusion scan, and computed tomography. RESULTS All 4 patients were symptomatic. The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. Echocardiography showed dilatation of the coronary artery in all 4 patients, and traced down its origin in 3 and drainage in 4. The fistulas originated from the right coronary artery in 2 patients and left coronary artery in 2, and were drained into the right ventricle in 2, right atrium in 1, and pulmonary artery in 1. Single left coronary artery was found in 1 patient. The pulmonary-to-systemic blood flow ratios ranged from 1.2 to 2.5. Transcatheter coil occlusion was successfully performed in 4 patients through a coaxial delivery system. The symptoms and signs of congestive heart failure and myocardial ischemia disappeared after the procedure. CONCLUSION Diagnosis of congenital CAVF could be achieved by appreciation of continuous murmur over area unusual for the ductus, and by scrupulous examination of echocardiography as well as angiography of the coronary artery through which coaxial transcatheter coil occlusion could be performed successfully.
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Affiliation(s)
- Meng-Luen Lee
- Department of Pediatrics, Division of Pediatric Cardiology, Changhua Christian Hospital, Changhua, Taiwan.
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33
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Wiegand G, Sieverding L, Kaulitz R, Hofbeck M. Transarterial and transvenous approach for transcatheter closure of a large coronary artery fistula with the Amplatzer vascular plug. Pediatr Cardiol 2009; 30:172-5. [PMID: 18654814 DOI: 10.1007/s00246-008-9266-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/22/2008] [Indexed: 11/27/2022]
Abstract
Interventional occlusion of coronary artery fistulas has become a well-accepted alternative to surgical therapy. However, occlusion of high-flow lesions in children, necessitating implantation of large occluding devices, may be limited by the requirement of large delivery catheters. This report describes the interventional occlusion of a large coronary artery fistula in an 8-year-old girl. Complete occlusion was achieved by subsequent transvenous and transarterial implantation of two Amplatzer vascular plugs (AVP). The AVP is an interesting alternative for interventional occlusion of large coronary artery fistulas in children that can be deployed safely by rather small guiding catheters.
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Affiliation(s)
- G Wiegand
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Strabetae 1, 72076, Tuebingen, Germany.
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34
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The Amplatzer vascular plug for large vessel occlusion in the endovascular management of aneurysms. Eur Radiol 2008; 18:2006-12. [DOI: 10.1007/s00330-008-0967-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 01/30/2008] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
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35
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Confluence at distal end of multiple coronary artery fistulae: two cases treated with interventional approach. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200803010-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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