Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
Curr Cardiol Rep. 2023 Dec;25(12):1921-1932. doi: 10.1007/s11886-023-02007-0. Epub 2023 Dec 5.
Coronary artery fistulas (CAFs) are rare coronary anomalies that most often occur as congenital malformations in children. Although most children with CAFs are asymptomatic at the time of diagnosis, some present with symptoms of congestive heart failure in the setting of large left-to-right shunts. Others may develop additional complications including coronary artery ectasia and coronary thrombosis. Surgical and transcatheter closure techniques have been previously described. This review presents the classifications of CAFs in children and the short and long-term outcomes of CAF closure in children in the reported literature. We also summarize previously-reported angiographic findings and post-treatment remodeling characteristics in pediatric patients.
With advancements in cross-sectional imaging technologies, anatomic delineation of CAFs via these modalities has become crucial in procedural planning. Recent reports of surgical and transcatheter closure of CAFs in children have reported good procedural success and low rates of short-term morbidity and mortality. Distal-type CAFs have elevated risk for long-term sequelae post-closure compared to proximal-type CAFs. A recent report of a multi-institutional cohort also describes post-closure remodeling classifications which may predict long-term outcomes in these patients as well as guide individualized anticoagulation management. Invasive closure of significant CAFs via surgical or transcatheter techniques is feasible and safe in most children with good short and intermediate-term outcomes. However, close clinical and imaging follow-up is required to monitor for late complications even after successful closure. Antiplatelet and anticoagulation regimens remain important aspects of post-closure management, but the necessary intensity and duration of such therapy remains unknown.
冠状动脉瘘（CAF）是一种罕见的冠状动脉异常，多发生于儿童时期的先天性畸形。尽管大多数 CAF 患儿在诊断时无症状，但部分患儿因左向右分流较大而出现充血性心力衰竭的症状。其他患儿可能会出现其他并发症，包括冠状动脉扩张和冠状动脉血栓形成。之前已经描述了手术和经导管闭合技术。本综述介绍了儿童 CAF 的分类以及文献中报道的儿童 CAF 闭合的短期和长期结果。我们还总结了儿科患者以前报道的血管造影发现和治疗后的重塑特征。
随着横断面成像技术的进步，通过这些方式对 CAF 进行解剖学描绘对于手术规划至关重要。最近关于儿童 CAF 手术和经导管闭合的报告显示，手术成功率高，短期发病率和死亡率低。与近端型 CAF 相比，远端型 CAF 闭合后长期后遗症的风险更高。最近的一项多机构队列报告还描述了闭合后的重塑分类，这可能预测这些患者的长期结局，并指导个体化抗凝管理。通过手术或经导管技术对有症状的 CAF 进行有创闭合在大多数儿童中是可行且安全的，具有良好的短期和中期结果。然而，即使在成功闭合后，仍需要密切的临床和影像学随访，以监测迟发性并发症。抗血小板和抗凝治疗仍然是闭合后管理的重要方面，但这种治疗的必要强度和持续时间尚不清楚。
