Techniques for transcatheter closure of coronary artery fistulas

AIM:To explore the results of transcatheter closure of coronary artery fistulas (CAF) with various techniques according to the anatomy of the CAF. METHODS: Patients who underwent attempted device closure of CAF between January 1999 and December 2012 were recruited into this study. After cardiac evaluation, patients underwent cardiac catheterization and angiography. The fistulas were closed using various devices and approaches according to the anatomy of the CAF. RESULTS: Thirtysix patients (17 males) aged from 3 to 74 years (median age: 21 years) underwent attempted transcatheter closure of CAF. The fistulas originated from the left coronary artery in 13 cases, right coronary artery in 18 cases, both right and left in five cases, with drainage to left ventricle in seven cases, right atrium in seven cases, right ventricle in 14 cases, and pulmonary artery in eight cases. Successful occlusion was performed in 25 cases (69%). Transvenous device delivery was performed in nine patients with fistulas draining into the right atrium (n=5), right ventricle (n=3) and pulmonary artery (n=1). Transarterial device delivery was performed in 16 patients with fistulas draining into the left ventricle (n=3), right atrium (n=1), right ventricle (n=10) and pulmonary artery (n=2). Procedural complications included chest pain in two cases, STT changes in six cases and fistula recanalization in one case. CONCLUSION: Transcatheter closure of coronary fistula is feasible and safe in the anatomically suitable vessels but requires different techniques for closure.