Abstract:

Objective To analyze the efficacy,complications and prognosis of transcatheter closure (TCC) of congenital coronary artery fistula (CAF) in children. Methods Clinical data of patients diagnosed with CAF and underwent TCC from January 2013 to January 2021 were retrospectively analyzed. Results A total of 46 patients with CAF were enrolled in the study, including 22 boys and 24 girls, with median age of 36.0 (24.5-49.5) months and median body weight of 14.9 (12.2-20.0) kg. In 46 patients with CAF, the fistula shunt was3.4 (3.0-4.4) mm, and there were varying degrees of widening of the involved coronary artery with an internal diameter of 6.1 (4.5-7.8) mm at the opening. It was considered difficult to perform TCC in the other 9 patients. Among the 35 patients who underwent successful TCC, arteriovenous loop was established to perform retrograde closure in 15 patients. The other 20 patients underwent antegrade closure through the aorta. PDA device (8 cases), VSD device (2 cases), coil (3 cases) and vascular plug (22 cases) were used in these patients.Among the 35patients who underwent successful TCC, 10 patients showed immediate residual shunt after closure. Tiny residual shunt disappeared during follow-up in eight patients. Two patients still showed residual shunt at the last follow-up. Thrombosis formation was found in two cases. Conclusion TCC is a safe and effective method for the treatment of CAF in children. It is necessary to fully evaluate the course, opening and collateral vessels of CAF to improve the success of intervention. For patients suffering risk of thrombosis, a longer course of routine anticoagulation after TCC may be required.

Key words: coronary artery fistula, transcatheter closure, residual shunt, thrombosis formation, child