Closure of a coronary fistula with a transcatheter implantable coil

Large sized coronary artery fistulas are rare and diagnosed in only 0.05% of adult catheterized patients. Only a minority of these fistulas are operated upon. We describe a percutaneous technique to close a left coronary artery fistula draining into the right atrium in a 30-yr-old male patient. The fistula was closed by implantation of a trefoil coil, inserted through a catheter selectively advanced into the fistula.     

Congenital coronary fistula to right ventricle. Treatment with transcatheter coil embolization]

We report the case of a 3 year old girl with a congenital right coronary artery-right ventricle fistula demonstrated by two dimensional echocardiography with color-flow Doppler and cardiac catheterization and angiography. The treatment was percutaneous transcatheter embolization by two detachable coils (7 mm x 20 cm and 6 mm x 20 cm) with successful complete occlusion. There were no complications.     

Successful transcatheter coil embolization of coronary artery fistula in an infant

Congenital coronary artery fistula is a rare anomaly that can cause several types of morbidity as well as mortality. Recently, transcatheter coil embolization for congenital coronary artery fistula has been advocated as an effective alternative to surgical repair and is associated with a low morbidity and good clinical outcome. We report a 49-day-old infant who had tachycardia, tachypnea, prolonged and interrupted feeding, cardiomegaly, and continuous murmur, and who underwent successful transcatheter coil embolization for a congenital right coronary artery fistula. At review 1 year after coil occlusion showed that serial plain chest radiographs, myocardial enzyme analysis, electrocardiography, and wall motion on echocardiography were normal.     

Exercise-induced ventricular tachycardia associated with coronary arteriovenous fistula and correction by transcatheter coil embolization

Exercise-induced ventricular tachycardia is a well-described arrhythmia most commonly associated with atherosclerotic coronary artery disease. The case reported here presents its association with a coronary arteriovenous fistula, which has not been previously reported in the literature. Cathet. Cardiovasc. Intervent. 46:470–472, 1999. © 1999 Wiley-Liss, Inc.     

Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system.

We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.     

Closure of an iatrogenic coronary artery fistula with a PTFE-coated stent

Acquired coronary-cameral fistula is an uncommon disorder. We describe a 50-year-old man with rheumatic valvular disease who required emergency mitral and aortic valve replacement due to Staphylococcus aureus acute infective endocarditis. He underwent further surgical interventions due to bleeding and prosthetic dehiscence. During follow-up, a continuous parasternal murmur was noted. Echocardiography showed continuous coronary fistula flow from the left anterior descending artery to the right ventricle. Elective closure of the ostium was achieved with direct implantation of a 3.5 x 16 mm PTFE-coated stent (Jostent Coronary System Graft, Jomed, Germany).     

High-output congestive heart failure successfully treated with transcatheter coil embolization of a large renal arteriovenous fistula.

Left heart catheterization was performed in response to progressive congestive heart failure of uncertain etiology in a 59-year-old male. The coronary arteries were normal but screening abdominal aortography revealed a large arterial venous communication between the left inferior segmental renal artery and the ipsilateral renal vein. The massive size and brisk flow patterns in the fistula presented technical challenges for transcatheter closure. The use of multiple Amplatz vascular obstructive devices (spiders) to create a matrix for securing subsequent coils in staged procedures and the patient's progress following successful closure are discussed.     

Neonatal transcatheter occlusion of a large coronary artery fistula with Amplatzer duct occluder.

A large fistula from the right coronary artery to the right atrium was diagnosed in a fetus at 22 weeks of gestation. Following delivery, the baby developed cardiac failure. The fistula was occluded at 3 weeks of age by transcatheter implantation of an Amplatzer duct occluder. Large coronary fistulas can be closed safely with a device even at this early age. Vigilance for ischemic events is required following implantation because of the rare possibility of thrombus extension proximally into the native coronary artery or spasm of the coronary artery.     

Traumatic aortic dissection and coronary fistula treated with transcatheter management.

An adolescent male presented with a dissection of the thoracic aorta and a left anterior descending coronary artery to right ventricular fistula following a road traffic accident. Authors report the management of this patient using a transcatheter approach for both these arterial issues, with stenting to the thoracic aorta and coil embolization of the coronary artery to right ventricular fistula as a staged procedure, along with a brief review of the literature on traumatic arterial injuries.     

Transbrachial coil embolization of a giant coronary artery fistula

Coronary artery fistulae can present late in adult life. We describe the case of a 71-year-old woman who developed a right coronary fistula, which was managed by percutaneous transbrachial coil embolization. Complete closure of the fistula was confirmed by follow-up angiography at 10 months.     

Coronary artery fistula. Management and intermediate-term outcome after transcatheter coil occlusion

During the last 2 decades, transcatheter occlusion of coronary artery fistulae has developed into a safe and effective therapy for children. This procedure avoids the need for open surgical repair and the attendant complications of cardiopulmonary bypass and median sternotomy. The long-term outcome in patients after transcatheter occlusion remains unknown. We describe the intermediate-term progress of 4 such patients after coil occlusion of coronary artery fistulae. Persistent coronary artery dilatation was present in all patients reviewed, as late as 4 years after occlusion.     

Successful transcatheter coil embolization of coronary artery to left ventricular fistula associated with absent pulmonary valve with tricuspid atresia in early infancy.

Transcatheter coil embolization for coronary artery to left ventricular fistula was successfully performed in a neonate. At 30 weeks' gestation, fetal echocardiography showed a hypoplastic right ventricle with intact ventricular septum, absent pulmonary valve, tricuspid atresia, and marked distension of the right coronary artery. After birth, the neonate had congestive heart failure and the electrocardiogram showed myocardial ischemic changes in the left ventricular area. Aortography showed a dilated right coronary artery arising from the ascending aorta and draining into the left ventricle. Transcatheter coil embolization was carried out on the 9th day after birth. Since the procedure, no myocardial ischemic changes have been detected. Transcatheter coil embolization is a useful therapy for coronary artery fistula associated with myocardial ischemia.     

An unusual case of an accessory coronary artery to pulmonary artery fistula: successful closure with transcatheter coil embolization

Coronary artery fistulae (CAF) are rare congenital anomalies. Surgical ligation is the standard treatment for symptomatic CAF, but is associated with higher morbidity. In a select group of patients, transcatheter coil embolization (TCE) is a reasonable alternative to standard surgical treatment. In this article, we present a unique (not previously reported) case of a tortuous accessory anomalous right coronary artery to pulmonary artery fistula with coronary steal phenomenon. TCE of highly tortuous fistulae can be technically difficult and are usually referred for surgery. In this case report we describe how utilization of adult coronary interventional wires and balloon catheters may help overcome some of the technical difficulties encountered with catheter-based closure of CAF.     

Transcatheter coil embolization of coronary artery fistula

Between December 1982 and August 2001, coil embolization of coronary artery-to-cardiac chamber fistula was attempted in 15 patients aged 11 months to 44 years (mean, 7.2 +/- 2.5 years). The fistulae connected the left anterior descending artery to the right ventricle in 4 patients, the right coronary artery to the right ventricle in 3, the right coronary artery to the right atrium in 3, the circumflex artery to the right ventricle in 2, the circumflex artery to the right atrium in 2, and the right coronary artery to the trunk of the pulmonary artery in 1. Complete fistula occlusion was achieved in 14 patients (93%); one had a residual shunt and underwent repeat embolization one year later, resulting in complete occlusion. There was one early death (7%) in a 4-year-old girl who developed femoral artery thrombosis and acute renal failure. Complications comprised migration of the coil into the pulmonary artery (2), femoral artery thrombosis (2), and perforation of the vessel wall by the guidewire (1) with immediate thrombosis and occlusion of the fistula (no coil was deployed). The 13 survivors with coils were followed up for 0.5 to 13 years; complete occlusion of the fistula was confirmed in all cases.     

Bioptome-assisted coil occlusion of coronary artery fistula

We describe a novel technique that allows controlled and precise delivery of single or multiple coils simultaneously for occlusion of a coronary artery fistula using a bioptome passed via a long sheath positioned at the distal end of the fistula. The fistula was balloon occluded distal to the take-off of the native branches before, during and after coil delivery in two patients.     

经导管弹簧圈栓堵法治疗先天性冠状动脉瘘

目的　探讨经导管弹簧圈栓堵冠状动脉瘘的安全性和有效性。方法　总结我院 1999年 5月至 2 0 0 2年 12月 6例 38～ 70岁 (平均年龄 5 0 7岁 )的先天性冠状动脉瘘进行栓堵治疗的患者 ,其中冠状动脉瘘由左冠状动脉至肺动脉 2例、右冠状动脉至肺动脉 2例、右冠状动脉至右下肺静脉及双侧冠状动脉至肺动脉各 1例。结果　 5例 (83 3% )栓堵后完全闭合 ;1例因瘘管迂曲 ,导管到位困难而放弃介入治疗。无手术死亡及并发症。 5例患者经体检和超声心动图随访 3～ 4 6个月 ,无残余瘘 ,无复发。结论　经导管弹簧圈栓堵先天性冠状动脉瘘不用开胸 ,病人易接受 ,安全、有效、方便 ,可作为治疗冠状动脉瘘的一种方法。     

A complicated percutaneous coil embolisation of a large coronary artery fistula

A coronary artery fistula is a rare cause of cardiac symptoms or signs in an adult. We report here the successful percutaneous treatment of a large fistula in an adult who had suffered an acute myocardial infarction peri-operatively due to a steal phenomenon. Due to the fistula size, a specially constructed occlusion device was utilised for effective treatment.     

Congenital coronary artery fistula draining into the right ventricle: successful surgical closure after failed transcatheter coil embolization

Coronary artery aneurysms and fistulae are very rare congenital anomalies. They occur in 0.2-0.4 % of all congenital heart diseases. In this article, we report a case of a four-year-old girl with a right coronary artery aneurysm and fistula draining into the right ventricle. Since the transcatheter coil embolization was not successful, surgical occlusion was considered in this case. We describe and discuss the handling of the fistula and the aneurysmatic enlargement of the proximal coronary artery.