Mid-Term Follow-Up of Transcatheter Closure for Coronary Cameral Fistula in Pediatrics.

BACKGROUND: Coronary cameral fistula (CCF), a rare abnormal coronary communication to cardiac chambers, may lead to coronary steal phenomenon and increase cardiac overload. We investigated the clinical and cardiovascular characteristics in children before and after transcatheter closure.
METHODS: We retrospectively reviewed pediatric patients with CCFs diagnosed by echocardiography in a tertiary medical center between 1998 and 2019. Basic information, echocardiogram, catheterization and interventional procedures were obtained from medical charts.
RESULTS: A total of 12 pediatric subjects were included. The median ages at diagnosis and catheterization were 0.2 and 2.8 years, respectively. All CCFs were unilateral and single with varying degrees of coronary artery dilatation and aneurysm formation and diagnosed by echocardiography. The median follow-up periods before and after catheterization were 2.5 and 7.3 years, respectively. Seven of the CCFs originated from the left side. The drainage sites were all right hearts. Before catheterization, the median size of the proximal end of the fistula was 3.1 mm, concomitant with enlargement of conduit coronary arteries. Eleven of the 12 patients underwent transcatheter closure using coils in six and vascular plugs in five. Only one patient had a significant increase in pulmonary-to-systemic flow ratio. The size of conduit coronary artery gradually decreased and the size of ipsilateral coronary branch increased after closure.
CONCLUSIONS: Transcatheter occlusion for CCFs in children is safe and effective. The morphology of CCFs varies with the degrees of dilation, tortuosity, and aneurysmal formation. After occlusion, alterations in the size of coronary arteries may be a prognostic indicator.