Remodeling and thrombosis following closure of coronary artery fistula with review of management: Large distal coronary artery fistula - To close or not to close?

Srinath T. Gowda, Thomas J. Forbes, Harinder Singh, Julie A. Kovach, Lourdes Prieto, Larry A. Latson, Daniel Turner

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

Background To evaluate postdiscovery outcome of coronary artery fistulae (CAF). CAF treatment sequelae and risk factors for coronary thrombosis have not been adequately evaluated. Methods Outcome on follow-up of 16 patients with CAF was reviewed. Risk factors for adverse coronary events were assessed based on type, size, and treatment of CAF. Results Median age was 10 years (0.01-56). Seven patients had large, four medium, and five small sizes CAF. Eight had proximal and 8 distal type CAF. There were 7 in the intervention group (IG) and 9 in nonintervention (NIG). In the IG, 1 had myocardial infarction (MI) <24 hr with distal thrombosis following large distal type CAF closure. Follow-up angiograms in 6 pts showed; decrease in conduit coronary artery size towards normal in 4, 1 had discrete intimal stenosis, persistent coronary dilatation in 1, thrombosis of residual proximal fistula segment without MI in 2, evidence of revascularization in 2 and neovascularization in 1 patient. In the NIG, 6 of the 9 pts available for follow-up were asymptomatic. Angiogram available in 1 patient showed persistent coronary dilatation with partial closure. Conclusion Post-CAF treatment sequelae include thrombosis and MI, revascularization, persistent coronary dilatation, remodeling, and decrease in conduit coronary artery size towards normal. The large size distal type of CAF may be at highest risk for coronary thrombosis post closure. The optimal treatment approach to various morphologies of CAF at various ages remains to be determined.

Original languageEnglish
Pages (from-to)132-142
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume82
Issue number1
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

Keywords

  • coronary artery fistula
  • remodeling
  • thrombosis
  • treatment

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