Transcatheter closure of congenital coronary artery fistulae: Immediate and long-term follow-up results

Background: Transcatheter closure of coronary artery fistulae (CAF) has emerged as an alternative to surgery, but there are no long-term outcome results. Objective: We report immediate and long-term results in 24 patients after transcatheter closure of congenital CAF. Methods: A total of 24 patients aged 5 to 56 years old with congenital CAF underwent attempted percutaneous transcatheter closure using various devices between November 1998 and August 2008. The immediate closure results and clinical follow-up were reviewed. Results: Of the 24 patients, 20 (83.3%) underwent successful transcatheter closure using various devices. An angiogram right after device deployment revealed complete occlusion in 15 patients (75%) and trivial- to-mild-residual flow in 5 patients (25%). Four patients (20%) had transient ST-T wave changes after the procedure. The left ventricular end-diastolic volume decreased from 165 ± 31.4 mm³ to 128.6 ± 24.4 mm³ (P = 0.012) 24 hours after procedure, and the cardiothoracic ratio from 0.57 ± 0.02 to 0.53 ± 0.01 (P = 0.003). Follow-up was 100% complete and ranged from 3 months to 10 years. There were no early or late deaths. All patients were asymptomatic with complete closure of CAF except 1 patient (5%) who had a recurrence of shunt at 6-month follow-up, which was re-closed by percutaneous technique. Conclusion: Transcatheter closure of CAF is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients.