Percutaneous closure of congenital coronary artery fistulae: Results and angiographic follow-up

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.