Management of coronary artery fistulae

Patient selection and results of transcatheter closure

Laurie Armsby, John F. Keane, Megan C. Sherwood, Joseph M. Forbess, Stanton B. Perry, James E. Lock

Research output: Contribution to journalArticle

305 Citations (Scopus)

Abstract

OBJECTIVES: We report short-term findings in 33 patients after transcatheter closure (TCC) of coronary artery fistulae (CAF) and compare our results with those reported in the recent transcatheter and surgical literature. BACKGROUND: Transcatheter closure of CAF has been advocated as a minimally invasive alternative to surgery. METHODS: We reviewed all patients presenting with significant CAF between January 1988 and August 2000. Those with additional complex cardiac disease requiring surgical management were excluded. RESULTS: Of 39 patients considered for TCC, occlusion devices were placed in 33 patients (85%) at 35 procedures and included coils in 28, umbrella devices in 6 and a Grifka vascular occlusion device in 1. Post-deployment angiograms demonstrated complete occlusion in 19, trace in 11, or small residual flow in 5. Follow-up echocardiograms (median, 2.8 years) in 27 patients showed no flow in 22 or small residual flow in 5. Of the 6 patients without follow-up imaging, immediate post-deployment angiograms showed complete occlusion in 5 or small residual flow in 1. Thus, complete occlusion was accomplished in 27 patients (82%). Early complications included transient ST-T wave changes in 5, transient arrhythmias in 4 and single instances of distal coronary artery spasm, fistula dissection and unretrieved coil embolization. There were no deaths or long-term morbidity. Device placement was not attempted in 6 patients (15%), because of multiple fistula drainage sites in 4, extreme vessel tortuosity in 1 and an intracardiac hemangioma in 1. CONCLUSIONS: A comparison of our results with those in the recent transcatheter and surgical literature shows similar early effectiveness, morbidity and mortality. From data available, TCC of CAF is an acceptable alternative to surgery in most patients.

Original languageEnglish (US)
Pages (from-to)1026-1032
Number of pages7
JournalJournal of the American College of Cardiology
Volume39
Issue number6
DOIs
StatePublished - Mar 20 2002
Externally publishedYes

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Patient Selection
Fistula
Coronary Vessels
Equipment and Supplies
Angiography
Morbidity
Spasm
Hemangioma
Blood Vessels
Dissection
Cardiac Arrhythmias
Drainage
Heart Diseases
Mortality

ASJC Scopus subject areas

  • Nursing(all)

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Management of coronary artery fistulae : Patient selection and results of transcatheter closure. / Armsby, Laurie; Keane, John F.; Sherwood, Megan C.; Forbess, Joseph M.; Perry, Stanton B.; Lock, James E.

In: Journal of the American College of Cardiology, Vol. 39, No. 6, 20.03.2002, p. 1026-1032.

Research output: Contribution to journalArticle

Armsby, Laurie ; Keane, John F. ; Sherwood, Megan C. ; Forbess, Joseph M. ; Perry, Stanton B. ; Lock, James E. / Management of coronary artery fistulae : Patient selection and results of transcatheter closure. In: Journal of the American College of Cardiology. 2002 ; Vol. 39, No. 6. pp. 1026-1032.
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abstract = "OBJECTIVES: We report short-term findings in 33 patients after transcatheter closure (TCC) of coronary artery fistulae (CAF) and compare our results with those reported in the recent transcatheter and surgical literature. BACKGROUND: Transcatheter closure of CAF has been advocated as a minimally invasive alternative to surgery. METHODS: We reviewed all patients presenting with significant CAF between January 1988 and August 2000. Those with additional complex cardiac disease requiring surgical management were excluded. RESULTS: Of 39 patients considered for TCC, occlusion devices were placed in 33 patients (85{\%}) at 35 procedures and included coils in 28, umbrella devices in 6 and a Grifka vascular occlusion device in 1. Post-deployment angiograms demonstrated complete occlusion in 19, trace in 11, or small residual flow in 5. Follow-up echocardiograms (median, 2.8 years) in 27 patients showed no flow in 22 or small residual flow in 5. Of the 6 patients without follow-up imaging, immediate post-deployment angiograms showed complete occlusion in 5 or small residual flow in 1. Thus, complete occlusion was accomplished in 27 patients (82{\%}). Early complications included transient ST-T wave changes in 5, transient arrhythmias in 4 and single instances of distal coronary artery spasm, fistula dissection and unretrieved coil embolization. There were no deaths or long-term morbidity. Device placement was not attempted in 6 patients (15{\%}), because of multiple fistula drainage sites in 4, extreme vessel tortuosity in 1 and an intracardiac hemangioma in 1. CONCLUSIONS: A comparison of our results with those in the recent transcatheter and surgical literature shows similar early effectiveness, morbidity and mortality. From data available, TCC of CAF is an acceptable alternative to surgery in most patients.",
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