Right coronary artery fistula with congestive heart failure in the neonate. Doppler echocardiographic diagnosis and closure with detachable balloon

Rivera, Ivan Romero; Moisés, Valdir Ambrósio; Tebexreni, Antônio Sérgio; Silva, Celia Camelo; Andrade, José L.; Fo, Orlando Campos; Carvalho, Antônio Carlos

doi:10.1590/s0066-782x2000000300006

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Transarterial device delivery was performed in 33 patients in Armsby series of 35 procedures which included coils in 28, umbrella devices in 6 and Grifka vascular occlusion device in 1 (7). Riviera et al reported a successful transcatheter detachable balloon occlusion of a right CAF in a neonate (8). Trehan et al reported that coils were used to close smaller fistulas (<4 mm at site of drainage), while devices and detachable balloons were used to close larger (9).…”

Section: Discussionmentioning

confidence: 99%

Transcatheter closure of congenital coronary arteriovenous fistula using detachable balloon technique

Çevik

Tavli²,

Sarıtaş³

et al. 2010

Anadolu Kardiyol Derg

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Section: Discussionmentioning

confidence: 99%

Transcatheter closure of congenital coronary arteriovenous fistula using detachable balloon technique

Çevik

Tavli²,

Sarıtaş³

et al. 2010

Anadolu Kardiyol Derg

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“…We, therefore, recommend closure (TCC or SC) of the fistula near the point of origin from the conduit coronary artery, with or without closure of the distal draining point, to eliminate a residual sac or dilated segment as a nidus for thrombus formation. 11,12,15,16 Distal CAF…”

Section: Proximal Cafmentioning

confidence: 99%

Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry

Gowda

Latson

Sivakumar

et al. 2021

Circ: Cardiovascular Interventions

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Background: Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. Methods: A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. Results: Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01–1) and 4.2 kg (1.7–10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1–18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. Conclusions: Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.

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Coronary Arterial Fistula

2009

The Natural and Unnatural History of Congenital Heart Disease

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Congenital coronary artery fistula is a rare abnormality in which a branch of either coronary artery communicates with a cardiac chamber or with the pulmonary trunk. Recently Papaioannou and his colleagues (1962) reviewed 70 adequately documented cases, including one of their own; in 18 of these a branch of the right coronary artery entered the right ventricle. A further patient with this anomaly is described here, with observations on the problem of diagnosis and a possible surgical approach to the correction of the lesion. Case ReportA man, aged 31 when he died, was first seen at this hospital in 1957 six years previously, when he was admitted for a hernia operation. He had been attending a physician elsewhere and was known to have congenital heart disease, which was then symptomless. At no time did he have a continuous murmur.On examination, he had a collapsing pulse with capillary pulsation and a wide pulse pressure (blood pressure 150/45 mm. Hg). There was no cyanosis or clubbing and the venous pressure was normal. The heart was very large with hypertrophy of both ventricles. There was a very loud pan-systolic murmur, with thrill, maximal in the third intercostal space to the left of the sternum, an apical mid-diastolic murmur, and a soft blowing early-diastolic murmur down the left border of the sternum. The second sound was normally split. The electrocardiogram showed left ventricular hypertrophy, without ST or T wave changes but with notching of the R wave in leads I and V6 (Fig. la). On the chest radiograph there was enlargement of aorta and pulmonary trunk, and considerable pulmonary plethora. At cardiac catheterization, a large left-toright shunt at ventricular level was demonstrated (pulmonary/systemic flow ratio approximately 4:1), the pulmonary arterial pressure was slightly raised (35/7 mm. Hg above the sternal angle), and the pulmonary vascular resistance was normal. He was thought to have a ventricular septal defect with aortic regurgitation, but the discrepancy between the width of the pulse pressure and the inconspicuous early diastolic murmur was noted. Operation was not advised as he was then symptomless and as the presence of presumably free aortic reflux would have posed problems which at that time were insuperable.He was not seen again until five years later when he returned with increasing effort dyspncea and palpitation, and was found to have atrial fibrillation, with clinical and radiological evidence of pulmonary congestion. The signs were otherwise unchanged (phonocardiogram shown in Fig. lc), but the electrocardiogram now showed evidence of right ventricular hypertrophy (Fig. lb). The blood pressure was 170/30 mm. Hg. In spite of treatment his condition deteriorated, and he was readmitted to hospital with right and left ventricular failure, pulmonary infarction, and secondary chest infection. He never improved sufficiently for further investigations to be undertaken, and he died in May 1963.At necropsy (Dr. W. J. Hanbury) there was peripheral cedema, with pleural, pericardial, and p...

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Right coronary artery fistula with congestive heart failure in the neonate. Doppler echocardiographic diagnosis and closure with detachable balloon

Cited by 3 publications

References 8 publications

Transcatheter closure of congenital coronary arteriovenous fistula using detachable balloon technique

Transcatheter closure of congenital coronary arteriovenous fistula using detachable balloon technique

Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry

Coronary Arterial Fistula

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