Percutaneous coronary artery fistula closure in adults: technical and procedural aspects

Abstract

Background: Coronary artery fistulae (CAF) are an uncommon congenital anomaly characterized by an abnormal connection between the coronary arteries and cardiac chambers or vessels without traversing the usual capillary network. CAF are associated with a number of well-described symptomatic sequelae, which may necessitate treatment. With a tendency for symptoms to develop over time, symptomatic CAF may present for the first time in adulthood, with limited data existing on the technical aspects related to transcatheter fistula closure in adults.

Methods: We describe our experience in percutaneous closure of CAF in an exclusively adult population, with an emphasis on the various procedural features of device closure in this patient group.

Results: Attempted transcatheter CAF closure was performed in 14 patients between 1990 and 2006. Procedural success was achieved in 11 patients, with vessel tortuosity and lumen caliber important limitations in occlusion device delivery. Procedural complications included vessel dissection and device embolization.

Conclusion: Transcatheter occlusion is a safe and effective method of therapy for symptomatic adults with CAF.