[Value of detachable silicone balloon in the closure of coronary artery fistula. Apropos of 3 cases]

Abstract

Surgical treatment of coronary artery fistulae is being progressively suppleated by interventional cardiology. Each method has its advantages and drawbacks. The authors report their experience with a silicone balloon inflated with contrast (ITC) and released into the fistula. Between May and September 1996, percutaneous embolisation of coronary artery fistulae was attempted by this technique in 3 children aged 8 months, 6 and 7 years. One had a right coronary artery to right ventricle fistula, the second had a right coronary artery to right atrium fistula and the third a left coronary artery to right ventricle fistula. The infant with a left-to-right shunt required digitalo-diuretic therapy and the 7 year old child had undergone surgical ligature with immediate repermeabilisation of the fistula 2 years previously. Catheterization was performed under general anaesthesia in 1 case and local anaesthesia in 2 cases. In all patients, complete occlusion was obtained when the balloon was inflated. However, in the infant, electrocardiogram signs of ischaemia were observed due to the distal origin of coronary vessels. The outcomes were uncomplicated. One child developed partial ischaemia of the lower limb which regressed with regressed with fibrinolysis and heparin therapy. The authors conclude that this is a reliable and safe technique for occluding large coronary artery fistulae. The results on the myocardium of occlusion can be assessed before final release of the balloon. For this reason, it may be proposed as the method of first intention before cardiac surgery.