Transcatheter embolization in the treatment of coronary artery fistulas
Author + information
- John F. Reidy, FRCP, FRCR*,1,
- Rui T. Anjos, MD1,
- Shakeel A. Qureshi, MRCP1,
- Edward J. Baker, MD, MRCP1 and
- Michael J. Tynan, MD, FRCP1
- ↵*Address for reprints: John F. Reidy, MD, Department of Radiology, Guy's Hospital, St. Thomas Street, London SE1 9RT, England.
Abstract
Seven patients with a coronary artery fistula underwent percutaneous transcatheter embolization (five were male and two female; the age range was 2 to 67 years [median 17]). Three patients were symptomatic. The left to right shunt ranged from 1.6 to 2.6:1. In six patients, the fistula was an isolated congenital anomaly; in one, it was acquired. The fistula arose from branches of the left (n = 5) and right (n = 2) coronary arteries and drained to the right ventricle (n = 2), right atrium (n = 2), coronary sinus (n = 1), pulmonary artery (n = 1) and a bronchial artery (n = 1).
Different embolization techniques were used to occlude eight feeding arteries. The embolization materials included a detachable balloon (n = 3), coaxial embolization with platinum microcoils (n = 3), a combination of detachable balloon and microcoil (n = 1) and standard steel coils (n = 1). Satisfactory occlusion was achieved in six patients. In one case, the valve of the detachable balloon was damaged, resulting in early balloon deflation and a residual fistula. There were no associated complications in any patient.
Follow-up investigation by Doppler ultrasound or coronary angiography 4 months to 4 years later showed that permanent occlusion was achieved in all six patients in whom embolization was initially successful. Transcatheter embolization should be considered the treatment of choice for coronary artery fistulas.
- Received August 28, 1990.
- Revision received January 8, 1991.
- Accepted January 21, 1991.
- American College of Cardiology Foundation
