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TRANSCATHETER CLOSURE OF
CORONARY ARTERY FISTULA

DR DO NGUYEN TIN
DAO ANH QUOC, MD
CHILDREN HOSPITAL 1, HCMC


AIM
• Describe the techniques used in transcatheter
closure of coronary artery fistula.
• Report our results with this procedure
• Compare our findings with those described in
the transcatheter and recent surgical
literature


INTRODUCTION
• Abnormal connection between one of the
coronary arteries and a heart chamber or
another blood vessel.
• Rare anomalies 0.002% population, 0.4%
cardiac malformations.
• Congenital or acquired.
• Continuous murmur.


HISTORY
•
•
•

•
•

The first described by Krause 1865.
Abbott: morphology of fistula 1906.
Bjork and Crafoord: surgical closure 1947.
Haller and Little: angiography for surgery 1963
Reidy: successful percutaneous closure 1983.


MORPHOLOGY
• Origination:
– RCA: 50% to 60%.
– LAD: 25% to 42%.
– Cx : 18.3%.
– Single fistulas :74% to 90%.
– Multiple fistulas occur in 10.7% to 16%.


• Drainage
– PA 15% to 43%.
– RV 14% to 40%.
– RA 19% to 26%.
– LV 2% to 19%.
– LA 5% to 6%.


Our series
• Origination :
– RCA : 67% (10/15).

– LCA : 27% (4/15).
– both coronary arteries : 7% (1/15).

• Drainage :
–
–
–
–
–

RV : 53% (8/15).
RA : 20% (3/15).
LA : 13% (2/15).
LV : 6,7% (1/15).
Complex fistula : 6,7% (1/15)


RCA to LA


LCA to RA


RCA to RV


RCA to LV


COMPLEX FISTULA

• Single fistula : 87% (13/15)
• Multiple fistula : 13% (2/15)
• Aneurysm : 40% (6/15)
– Simple : 50% (3/15)
– Complex : 50% (3/15)


Single fistula


Multiple fistula


Simple Aneurysm


Complex Aneurysm


Natural History and Complications
•
•
•
•
•

Spontaneous closure very uncommon.
Excessive load to cardiac chambers.

Coronary complications.
Valvular and endocardial complications.
Extracardiac complications.


SHOULD WE CLOSE THE FISTULA?
HOW AND WHEN?
• Closure has been recommended because of its
complications.
• Treatment by transcatheter or surgical closure
gives the best results.
• Performe early in the course of the disease.


PERFORMANCE
•
•
•
•
•

Retrograde : 38% (5/13)
Antegrade : 62% (8/13)
Vascular plug : 62% (8/13) (2 plugs in 1case)
Coils : 15% (2/13)
Umbrela device : 23% (3/13)


Retrograde with plug

Retrograde with ADOI


Retrograde with VSD muscular


Retrograde with ADOII


Antegrade with plug