Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
JACC Cardiovasc Interv. 2011 Jul;4(7):814-21. doi: 10.1016/j.jcin.2011.03.014.
This study sought to assess clinical and angiographic outcomes in a series of 29 patients who underwent transcatheter closure of coronary artery fistulae (CAF).
Transcatheter closure of CAF has become an alternative to surgical closure, but the reported experience is relatively limited.
Medical records of all patients with CAF who underwent transcatheter closure at the Mayo Clinic, Rochester, Minnesota, between 1997 and 2010, were reviewed. Patients with other complex cardiac lesions and those requiring surgery were excluded.
Twenty-nine patients with CAF underwent 36 transcatheter closure procedures. The most were women (55%), and the median age at the time of transcatheter closure was 49 years. Twenty-three patients had a single CAF. The most common presenting symptom was chest pain (52%). Thirty devices were deployed antegrade into 1 or more arterial feeders, 3 using an arteriovenous wire loop and 3 retrograde at the fistulous connection. Successful closure occurred immediately in all patients with no residual flow in 89% and with trivial flow in 11%. Four complications occurred including 2 device migrations, 1 coronary spasm, and 1 coronary thrombosis. A follow-up angiogram was obtained in 18 (62%) patients with a median time to follow-up angiography of 1.5 years. Ten patients (56%) of the 18 patients with follow-up angiography had no recanalization of embolized vessel; 4 patients (22%) had trivial recanalization, and 4 patients (22%) had large recanalization. A repeat closure procedure was performed in all 4 patients of the latter.
Transcatheter closure of CAF is feasible and should be considered in carefully selected patients. Recanalization of the treated coronary fistulae can occur, so follow-up angiography or other imaging modality should be performed in these patients.
本研究旨在评估 29 例接受经导管冠状动脉瘘（CAF）封堵术患者的临床和血管造影结果。
经导管 CAF 封堵术已成为手术封堵的替代方法，但报告的经验相对有限。
回顾 1997 年至 2010 年间明尼苏达州罗切斯特市梅奥诊所接受经导管 CAF 封堵术的所有 CAF 患者的病历。排除有其他复杂心脏病变和需要手术的患者。
29 例 CAF 患者共行 36 次经导管封堵术。女性（55%）居多，经导管封堵时的中位年龄为 49 岁。23 例患者存在单个 CAF。最常见的首发症状是胸痛（52%）。30 个封堵器经顺行进入 1 个或多个动脉供血支，其中 3 个使用动静脉导丝环，3 个经瘘口逆行进入。所有患者即刻封堵成功，89%无残余分流，11%仅有少量分流。4 例发生并发症，包括 2 例封堵器移位、1 例冠状动脉痉挛和 1 例冠状动脉血栓形成。18 例（62%）患者获得随访血管造影，中位随访时间为 1.5 年。18 例有随访血管造影的患者中，10 例（56%）栓塞血管无再通；4 例（22%）轻度再通，4 例（22%）重度再通。后者所有 4 例患者均行重复封堵术。
经导管 CAF 封堵术是可行的，应在仔细选择的患者中考虑应用。治疗后的冠状动脉瘘可能会再通，因此这些患者应行随访血管造影或其他影像学检查。
