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Transcatheter embolization of congenital coronary arterial fistulas in adults

Published online by Cambridge University Press:  19 August 2008

Antônio M. Kambara ,
Carlos A. C. Pedra ,
C,sar A. Esteves ,
Manoel N. Cano ,
Sérgio L. N. Braga ,
Amanda G. M. R. Souza ,
J. Eduardo M. R. Souza  and
Valmir F. Fontes
Antônio M. Kambara
Affiliation:
Director of Radiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
Carlos A. C. Pedra*
Affiliation:
Assistants of Invasive Cardiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
C,sar A. Esteves
Affiliation:
Assistants of Invasive Cardiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
Manoel N. Cano
Affiliation:
Assistants of Invasive Cardiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
Sérgio L. N. Braga
Affiliation:
Assistants of Invasive Cardiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
Amanda G. M. R. Souza
Affiliation:
Director of Invasive Cardiology Department, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
J. Eduardo M. R. Souza
Affiliation:
Director of “Instituto Dante Pazzanese de Cardiologia”, “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
Valmir F. Fontes
Affiliation:
Director of Diagnostic and Therapeutic Methods Division, Departments of Interventional Radiology and Cardiology of “Instituto Dante Pazzanese de Cardiologia”, Sao Paulo, Brazil
*
Carlos A. C. Pedra, Instituto “Dante Pazzanese” de Cardiologia, Av. Dr Dante Pazzanese 500, CEP 04012–180 S©o Paulo – SP, Brazil. Tel: 5511(5085–4114); Fax: 5511(571–5621); E-mail: pedracac@mandic.com.br
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Abstract

In this report, we describe our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. From November 1992 to November 1996, 5 symptomatic patients, aged from 47 to 70 years, underwent transcatheter occlusion of fistulas using a retrograde arterial approach. All had chest pain or dyspnea on exertion. Detachable balloons were used in 4 patients, and Gianturco coils in 1. Detachable balloons were implanted through a Debrun system, while the coils were implanted through a 5 French right coronary Judkins catheter. Both were passed through an 8 French guiding catheter (Amplatz II). Each patient had a single fistula. The fistulas originated from the right coronary artery in 3 patients, and from the circumflex artery in 2. They drained into the pulmonary trunk in 3 patients, into the right atrium in 1, andinto a bronchial artery in the other. All fistulas were occluded completely in the catheterization laboratory, and the procedures were uncomplicated. At follow up, 3 patients underwent coronary angiography, and there was no evidence of recanalization. Transcatheter embolization in adults of single congenital coronary fistulas with detachable balloons and coils is safe and effective and can be regarded as an acceptable alternative to surgery.

Keywords

Coronary artery fistulastranscatheter embolizationtreatment
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 4 , July 1999 , pp. 371 - 376
Copyright
Copyright © Cambridge University Press 1999

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References

1.Hoffman, JIE. Congenital Anomalies of the Coronary Vessels and the Aortic Root. In: Emmanouilides, GC, Riemenschneider, TA, Allen, HD, Gutgesell, HP (ed). Heart Disease in Infants, Children, and Adolescents including the Fetus and Young Adult. William and Wilkins, Baltimore, 1995, pp 780–782Google Scholar
2.Rittenhouse, EA, Doty, DB, Ehrenhaft, JL. Congenital coronary artery – cardiac chamber fistula. Review of operative management. Ann Thorac Surg 1975; 4: 468–85CrossRefGoogle Scholar
3.Baltaxe, HA, Wixson, D. The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology 1977; 122: 47–52.CrossRefGoogle ScholarPubMed
4.Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 28–40.CrossRefGoogle ScholarPubMed
5.Vavuranakis, M, Bush, CA, Boudoulas, H. Coronary artery fis-tulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn 1995; 35: 116–120.CrossRefGoogle ScholarPubMed
6.Levin, DC, Fellows, KE, Abrams, HL. Hemodynamically significant primary anomalies of the coronary artery. Angiographic aspects. Circulation 1978; 58: 25–34.CrossRefGoogle ScholarPubMed
7.Liberthson, RR, Sagar, K, Berkoben, JP, Weintraub, RM, Levine, FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 1979; 59: 849–854.CrossRefGoogle ScholarPubMed
8.Farooki, ZQ, Nowlen, T, Hakimi, M, Pinsky, WWCongenital coronary artery fistulae: a review of 18 cases with special emphasis on spontaneous closure. Pediatr Cardiol 1993; 14: 208–213.CrossRefGoogle ScholarPubMed
9.Davis, JT, Allen, HD, Wheller, JJ. Coronary artery fistula in the pediatric age group: a 19-year institutional experience. Ann Thorac Surg 1994; 58: 760–763.CrossRefGoogle ScholarPubMed
10.Urrutia-S, CO, Falashi, G, Ott, DA, Cooley, DA. Surgical management of 56 patients with congenital coronary artery fistula. Ann Thorac Surg 1983; 3: 300–307CrossRefGoogle Scholar
11.Mavroudis, C, Backer, CL, Rocchini, AP, Muster, AJ, Gevitz, M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg 1997; 63: 1235–1242.CrossRefGoogle ScholarPubMed
12.Bennett, JM, Maree, E. Successful embolization of a coronary artery fistula. Int J Cardiol 1989; 23: 405–06CrossRefGoogle Scholar
13.Strunk, BL, Hieshima, GB, Shafton, EPPercutaneous treatment of a congenital coronary arteriovenous malformation with micro-particle embolization. Cathet Cardiovasc Diagn 1991; 22: 133–136.CrossRefGoogle ScholarPubMed
14.Hartnell, GG, Jordan, SC. Balloon embolization of a coronary fistula. Int J Cardiol 1990; 29: 381–383CrossRefGoogle Scholar
15.Meier, B. Coronary occlusion after failed coronary pulmonary fistula with detachable balloon. Cathet Vase Diagn 1989; 18: 237–239.CrossRefGoogle ScholarPubMed
16.Reidy, JF, Tynan, MJ, Qureshi, SA. Embolisation of a complex coronary arteriovenous fistula in a 6 year old child: the need for specialised embolisation techniques. Br Heart J 1990; 63: 246–248.CrossRefGoogle Scholar
17.Reidy, JF, Anjos, RT, Qureshi, SA, Baker, EJ, Tynan, MJ. Transcatheter embolization in the treatment of coronary artery fistulas. J Am Coll Cardiol 1991; 1: 187–192.CrossRefGoogle Scholar
18.Perry, SB, Rome, J, Keane, JF, Bairn, DS, Lock, JE. Transcatheter closure of coronary artery fistulas. J Am Coll Cardiol 1992; 1: 205–209CrossRefGoogle Scholar
19.Krabill, KA, Hunter, WE. Transcatheter closure of congenital coronary fistula with a detachable balloon. Pediatr Cardiol 1993; 14: 176–178CrossRefGoogle ScholarPubMed
20.Cano, MN, Kambara, A, Maldonado, G, Mattos, LAP, Tanajura, LFL, Fontes, VF, Pinto, IMF, Feres, F, Sousa, AGMR, Sousa, JEMR. Tratamento n©o cir£rgico de fistula artrio venosa coronaria pulmonar. Arq Bras Cardiol 1993; 60: 189–191.Google Scholar
21.Skimming, JW, Gessner, IH, Victoria, BE, Mickle, JP. Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons. Pediatr Cardiol 1995; 16: 38–41CrossRefGoogle ScholarPubMed
22.Qureshi, SA, Reidy, JF, Alwi, BM, Lim, MK, Wong, J, Tay, J, Baker, EJ, Tynan, M. Use of interlocking detachable coils in embolization of coronary arteriovenous fistulas. Am J Cardiol 1996; 78: 110–113.CrossRefGoogle ScholarPubMed
23.Said, SAM, El, Gamal MIH. Coronary angiographic morphology of congenital coronary arteriovenous fistulas in adults. Report of 4 new cases and review of angiograms of fifteen reported cases. Cathet Cardiovasc Diagn 1995; 35: 29–35.CrossRefGoogle Scholar
24.Said, S. Doppler echocardiographic findings in coronary-pulmonary fistula. Int J Cardiol 1989; 25: 343–346.CrossRefGoogle ScholarPubMed
25.Fernandes, F, Alan, M, Smith, S, Khaja, F. The role of transesophageal echocardiography in indentifying anomalous coronary arteries. Circulation 1993; 88: 2532–2540.CrossRefGoogle Scholar
26.Giannoccaro, PJ, Sochowski, RA, Morton, BC, Chan, KL. Complementary role of transesophageal echocardiography to coronary angiography in the assessment of coronary artery anomalies. Br Heart J 1993; 70: 70–74.CrossRefGoogle ScholarPubMed
27.Kubota, S, Susuki, T, Murata, K. Cinemagnetic resonance imaging for diagnosis of right coronary arterial-ventricular fistula. Chest 1991; 100: 735–737.CrossRefGoogle Scholar
28.Said, SAM, Bucx, JJJ, van de, Weel. Stress MIBI scintigraphy in multiple coronary-pulmonary fistula: Fail to demonstrate “steal” phenomenon. Int J Cardiol 1992; 35: 270–272.CrossRefGoogle Scholar
29.Glynn, TP Jr, Flemming, RG, Haist, JL, Hunteman, RK. Coronary arteriovenous fistula as a cause for reversible thallium–201 perfusion defect. J Nucl Med 1994; 35: 1808–1810.Google ScholarPubMed
30.Oshiro, K, Shimanbukuro, M, Nakada, Y, Chibana, T, Yoshida, H, Nagamine, F, Sunagawa, R, Gushiken, M, Murakami, K, Mimura, G. Multiple coronay LV fistulas: demonstration of coronary steal phenomenon by stress thallium scintigraphy and exercise hemodynamics. Am Heart J 1990; 120: 217–219.CrossRefGoogle Scholar
31.Prakash, A, Reidy, JS, Holt, PM. Correction of myocardial ischaemia after transcatheter embolization of a small coronary artery fistula. Br Heart J 1993; 69: 270–271.CrossRefGoogle Scholar
32.St, John Sutton MG, Miller, GA, Ker, IH, Traill, TA. Coronary steal via large coronary artery to bronchial artery anastomosis successfully treated by operation. Br Heart J 1980; 44: 460–463.Google Scholar
33.Aggoun, Y, Bonhoeffer, P, Sidi, D, Bonnet, D, Acar, P, Kachaner, J. Congenital coronary-cardiac fistula in children. Effects of surgical occlusion and percutaneous embolization. Arch Mai Coeur Vaiss 1997; 90: 605–609.Google ScholarPubMed