Transcatheter closure of coronary artery fistulas

Vijay Trehan, Jamal Yusuf, Saibal Mukhopadhyay, Umamahesh Rangasetty, Vimal Mehta, Mohit D. Gupta, D. S. Gambhir, R. Arora

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Transcatheter closure of coronary artery fistulas has emerged as a successful alternative to surgery. We describe various techniques and short-term findings in 15 patients who were taken up for transcatheter closure of these fistulas. Methods and Results: Fifteen patients (aged 2-55 years; 12 males) with coronary artery fistulas underwent percutaneous transcatheter closure between June 1997 and December 2002. Site of origin of these fistulas were: right coronary artery in 7, left anterior descending coronary artery in 4, left main coronary artery in 2 and left circumflex coronary artery in 2 patients. Drainage site of these fistulas were: right ventricle in 9, right atrium in 4 and pulmonary artery in 2 patients. Out of these 15 fistulas, 14 were congenital and one was iatrogenically produced following inadvertent cutting balloon angioplasty of a septal perforator in a patient with chronic total occlusion of left anterior descending coronary artery. Various occlusion devices used to close these fistulas were: conventional metallic coils in 10, floppy tips of coronary angioplasty guidewires in 2, Amplatzer duct occluder in 1 and Amplatzer septal occluder in 2 patients. One of our patients had a coronary artery fistula draining by two openings into the right atrium, both of which were successfully closed using 2 Amplatzer duct occluders. Check angiogram after the procedure revealed complete occlusion in 13 (86.6%) and small residual flow in 2 patients. Follow-up studies at 3-55 months (mean 18 months) showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt. Conclusion: Transcatheter closure of coronary artery fistulas is feasible and safe in the anatomically suitable vessels. Use of floppy tips of coronary angioplasty guidewires reduces the cost of the procedure significantly, which is an important consideration in developing countries like India.

Original languageEnglish (US)
Pages (from-to)132-139
Number of pages8
JournalIndian Heart Journal
Volume56
Issue number2
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Fistula
Coronary Vessels
Septal Occluder Device
Heart Atria
Angioplasty
Balloon Angioplasty
Pulmonary Artery
Developing Countries
Heart Ventricles
Drainage
India
Angiography
Costs and Cost Analysis
Recurrence
Equipment and Supplies

Keywords

  • Amplatzer device
  • Coil embolization
  • Coronary artery fistulas

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Trehan, V., Yusuf, J., Mukhopadhyay, S., Rangasetty, U., Mehta, V., Gupta, M. D., ... Arora, R. (2004). Transcatheter closure of coronary artery fistulas. Indian Heart Journal, 56(2), 132-139.

Transcatheter closure of coronary artery fistulas. / Trehan, Vijay; Yusuf, Jamal; Mukhopadhyay, Saibal; Rangasetty, Umamahesh; Mehta, Vimal; Gupta, Mohit D.; Gambhir, D. S.; Arora, R.

In: Indian Heart Journal, Vol. 56, No. 2, 03.2004, p. 132-139.

Research output: Contribution to journalArticle

Trehan, V, Yusuf, J, Mukhopadhyay, S, Rangasetty, U, Mehta, V, Gupta, MD, Gambhir, DS & Arora, R 2004, 'Transcatheter closure of coronary artery fistulas', Indian Heart Journal, vol. 56, no. 2, pp. 132-139.
Trehan V, Yusuf J, Mukhopadhyay S, Rangasetty U, Mehta V, Gupta MD et al. Transcatheter closure of coronary artery fistulas. Indian Heart Journal. 2004 Mar;56(2):132-139.
Trehan, Vijay ; Yusuf, Jamal ; Mukhopadhyay, Saibal ; Rangasetty, Umamahesh ; Mehta, Vimal ; Gupta, Mohit D. ; Gambhir, D. S. ; Arora, R. / Transcatheter closure of coronary artery fistulas. In: Indian Heart Journal. 2004 ; Vol. 56, No. 2. pp. 132-139.
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AB - Background: Transcatheter closure of coronary artery fistulas has emerged as a successful alternative to surgery. We describe various techniques and short-term findings in 15 patients who were taken up for transcatheter closure of these fistulas. Methods and Results: Fifteen patients (aged 2-55 years; 12 males) with coronary artery fistulas underwent percutaneous transcatheter closure between June 1997 and December 2002. Site of origin of these fistulas were: right coronary artery in 7, left anterior descending coronary artery in 4, left main coronary artery in 2 and left circumflex coronary artery in 2 patients. Drainage site of these fistulas were: right ventricle in 9, right atrium in 4 and pulmonary artery in 2 patients. Out of these 15 fistulas, 14 were congenital and one was iatrogenically produced following inadvertent cutting balloon angioplasty of a septal perforator in a patient with chronic total occlusion of left anterior descending coronary artery. Various occlusion devices used to close these fistulas were: conventional metallic coils in 10, floppy tips of coronary angioplasty guidewires in 2, Amplatzer duct occluder in 1 and Amplatzer septal occluder in 2 patients. One of our patients had a coronary artery fistula draining by two openings into the right atrium, both of which were successfully closed using 2 Amplatzer duct occluders. Check angiogram after the procedure revealed complete occlusion in 13 (86.6%) and small residual flow in 2 patients. Follow-up studies at 3-55 months (mean 18 months) showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt. Conclusion: Transcatheter closure of coronary artery fistulas is feasible and safe in the anatomically suitable vessels. Use of floppy tips of coronary angioplasty guidewires reduces the cost of the procedure significantly, which is an important consideration in developing countries like India.

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