Coil Embolization of Coronary Artery Fistulas

Background and Purpose: Congenital coronary artery fistula (CAF) is an uncommon anomaly. In some patients they can became symptomatic, associated with significant morbidity and mortality. We report our experience in percutaneous treatment of CAF.

Congenital coronary artery fistula (CAF) can be defined as a direct communication of a coronary artery with a cardiac chamber, great vessel, or other vascular structure, bypassing the myocardial capillary bed. CAF is an uncommon anomaly, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. They are not gender specific. Many patients have symptoms like congestive heart failure, infective endocarditis, myocardial ischemia, or rupture of an aneurismal fistula. Surgical closure of coronary artery fistula was initially reported in 1983 with low rates of morbidity and mortality. Percutaneous treatment appeared as an alternative to surgery. Transcatheter closure of CAF was first utilized in 1983. Along this years, with experience and improvements in catheterization equipment and occlusion devices, CAF occlusion have been successfully performed using microcoils. We report our experience in using microcoils to percutaneous treatment of coronary fistulas.

Inclusion Criteria: Coronary artery fistulas Clinical diagnosis of angina, myocardial infarction, left ventricular insufficiency, ventricular enlargement Exclusion Criteria: Age <18 or > 85 years Cardiogenic shock _ severe ventricular enlargement