Diagnosis and Management of Congenital Coronary Artery Fistulas in Infants and Children

Wu, Stephan; Fares, Munes; Zellers, Thomas M.; Jyothinagaram, Maanya; Reddy, Surendranath R. Veeram

doi:10.1007/s11886-023-02007-0

Cited by 2 publications

(9 citation statements)

References 37 publications

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“…One of the significant complications is coronary steal-related chronic myocardial ischemia, which can lead to congestive heart failure [ 8 ]. Additionally, volume overload in the cardiac chamber can also contribute to heart failure [ 2 , 8 ]. Although our patients' stress test did not reveal signs of ischemia, they still carry a risk of developing these complications in adulthood [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, CAFs can occur in isolation or be associated with other congenital cardiac abnormalities, such as a single coronary artery [ 4 , 5 ]. The other type of CAF is acquired, resulting from surgery, trauma, or infection, but these are rarely observed in children [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…CAF classification is based on size into small, medium, and large fistulas. This classification is not solely determined by the actual size of the fistula but rather by its size relative to the adjacent or distal normal coronary artery branch [ 2 , 6 ]. While most CAFs are asymptomatic, some patients may experience arrhythmias, myocardial ischemia, or heart failure [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…From infancy to adulthood, CAFs can either regress spontaneously or lead to life-threatening complications, creating controversy over the best management approach. Treatment of CAFs varies depending on several factors, including the size and location of the fistula, age, symptoms, and the likelihood of complications in adulthood [ 2 , 6 ]. Surgical or transcatheter closure is the mainstay of treatment for medium to large CAFs in infants and children [ 2 , 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of CAFs varies depending on several factors, including the size and location of the fistula, age, symptoms, and the likelihood of complications in adulthood [ 2 , 6 ]. Surgical or transcatheter closure is the mainstay of treatment for medium to large CAFs in infants and children [ 2 , 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child

Semrin,

Colon Cortes,

Vranicar

et al. 2024

Cureus

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Coronary artery fistulas (CAFs) are rare cardiac anomalies characterized by an abnormal connection between the coronary arteries and either a cardiac chamber or a large thoracic vessel. While the majority of CAF cases are asymptomatic, serious cardiac complications can occur, especially with moderate to large fistulas. We describe a case of a large-sized left coronary artery (LCA) fistula in an asymptomatic 11-year-old who was referred for cardiac evaluation due to a systolic murmur. An echocardiogram revealed a hemodynamically significant fistula arising from the LCA draining into the right ventricle. Diagnostic catheterization confirmed the origin and draining site of the fistula, along with aneurysmal dilation at the end of the fistula. The fistula was successfully closed percutaneously using a two-coil occlusive device, with no complication observed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child

Semrin,

Colon Cortes,

Vranicar

et al. 2024

Cureus

View full text Add to dashboard Cite

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Embolization of a Large Right-Coronary-Artery-to-Left-Atrium Fistula in a Three-Year-Old Child: A Case Report

Krasic,

Butera,

Topic

et al. 2024

JCDD

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Objectives: Coronary artery fistulas (CAFs) are rare congenital anomalies with an occurrence rate of 0.002–0.3%. The right coronary artery (RCA) is reportedly the most common site of origin of CAFs, but fistulas draining to the left atrium (LA) are rare. We presented a three-year-old boy with a symptomatic congenital RCA-to-LA fistula, which was successfully percutaneously occluded with an Amplatzer vascular plug 4 (AVP4). Case report: The diagnosis was made by echocardiography when he was two months old. During the follow-up period of 2 years, a progressive dilatation of the RCA and enlargement of the left ventricle was detected, so treatment for congestive heart failure was initiated. At the age of three, the patient presented with a history of occasional mild central chest pain and discomfort and mild dyspnea on exertion. On a 24 h ECG Holter monitor, the depression of ST segments was registered. CT angiography highlighted a large type B RCA fistula to the LA, which extended along the atrioventricular sulcus. The proximal RCA diameter was 7 mm. The fistula was tortuous, with segmental narrowing and three curves. Cardiac catheterization was performed across the right femoral artery on the three-year-old boy (body weight: 13 kg). Across the 4F Judkins right guiding catheter, an AVP4 of 5 mm was placed in the distal part of the CAF connected with the delivery cable. After 15 min, ECG changes were not registered, so the device was released. Immediate post-deployment angiography demonstrated complete CAF occlusion, with satisfying flow in the distal coronary artery. The patient was discharged after four days. In the short-term follow-up period, the boy was symptom-free. Conclusions: In our experience, given the existence of the left-to-left shunt and the more pronounced exercise-induced coronary steal phenomenon that occurs in medium-sized and large CAFs, occlusion is necessary to prevent the further progression of clinical signs and symptoms.

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Diagnosis and Management of Congenital Coronary Artery Fistulas in Infants and Children

Cited by 2 publications

References 37 publications

Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child

Percutaneous Coil Closure of a Large Left Coronary Artery Fistula in an Asymptomatic Child

Embolization of a Large Right-Coronary-Artery-to-Left-Atrium Fistula in a Three-Year-Old Child: A Case Report

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