Percutaneous transcatheter closure of congenital coronary artery fistulae with patent ductus arteriosus occluder in children: focus on patient selection and intermediate-term follow-up results.

BACKGROUND

The prognostic implications of clinically silent coronary artery fistula (CAF) and its intermediate/long-term outcomes after transcatheter closure have not been well studied, especially in children.

AIMS

This study intended to determine the prognostic implications of asymptomatic CAF and to evaluate the intermediate follow-up outcomes following transcatheter occlusion with patent ductus arteriosus (PDA) in children.

METHODS

Eighteen children with congenital CAF were divided into two groups: the intervention group (n = 14; maximal coronary artery diameter [MCD] ≥5 mm and/or fistulous orifice diameter [FOD] >2 mm), and the non-intervention group (n = 4; MCD <5 mm and FOD ≤2 mm). Patients in the intervention group received percutaneous occlusion with PDA occluder. Clinical outcomes and follow-up data were analyzed and compared between different groups.

RESULTS

Patients with clinically silent CAF were followed for 8-130 months. At the mean follow-up of 36 months, patients in the non-intervention group did not show any changes in the measured parameters over time. In contrast, patients in the intervention group showed significant increase of MCD (8.31 ± 2.16 mm to 12.75 ± 3.01 mm; P=.001) and FOD (3.75 ± 3.42 mm to 4.82 ± 1.81 mm; P=.03). In addition, 3 cases of aneurysm formation and 2 cases of mild heart failure were detected before the patients received the attempted transcatheter closure. A total of 14 patients underwent cardiac catheterization with an attempt to close the CAF. Placement of occlusion devices succeeded in 10 patients (71.5%) and failed in 4 patients (28.5%). Ten children with successful transcatheter closure were followed 3-62 months (median, 36 months). At the medial time of 36 months, all patients with closure were in New York Heart Association functional class I and asymptomatic. The MCD decreased from 9.66 ± 3.86 mm to 7.82 ± 3.83 mm (P=.36).

CONCLUSION

All asymptomatic CAFs in children with MCD ≥5 mm and/or FOD >2 mm should be closed as early as possible to prevent later complications. Transcatheter closure of CAF using the PDA occluder is an effective and safe approach in appropriately selected children and showed favorable intermediate-term follow-up outcomes.