No abstract

Coronary artery fistulas are rare persisting vascular connections from a coronary artery to a cardiac chamber or major central blood vessel. The true incidence is difficult to discern because at least 75% may be asymptomatic and clinically undetectable until an echocardiogram or coronary arteriogram is performed. Small coronary artery fistulas that are not clinically detectable are not clearly associated with significant long term complications. Medium or large fistulas are associated with significant long term problems including angina, arrhythmias, myocardial infarction, endocarditis, and progressive dilation. Treatment options include surgical and catheter approaches to significant fistulas. The long term outlook after fistula closure is not well defined and deserves further study.

Transcatheter closure of a patent foramen ovale can be accomplished with little morbidity and may reduce the risk of recurrence. Further investigations directed toward identifying the population at risk and assessing the effect of intervention are warranted.

The use of stents in COA is a feasible alternative to surgical repair or balloon angioplasty in selected patients with an effective gradient reduction. Intermediate-term follow-up shows excellent gradient relief, with no complications in this group of patients.

Closure of ASD with the HELEX septal occluder is safe and effective when compared with surgical repair, with reduced anesthesia time and hospital stay. (U.S. Multicenter Pivotal Study of the HELEX Septal Occluder for Percutaneous Closure of Secundum Atrial Septal Defects; this study was approved by the Food and Drug Administration before the National Institutes of Health website was active, so there is not a URL or registration number.).