Open Access

ARTICLE

Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

Yifan Li¹, Zewen Chen², Yumei Xie¹, Shushui Wang¹, Zhiwei Zhang^1,*

1 Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, China
2 Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, China

* Corresponding Author: Zhiwei Zhang. Email:

Congenital Heart Disease 2023, 18(4), 413-430. https://doi.org/10.32604/chd.2023.029848

Received 10 March 2023; Accepted 16 May 2023; Issue published 15 September 2023

Abstract

Background: Limited data are available regarding intermediate and long-term outcomes of transcatheter closure (TCC) of coronary cameral fistulas (CCFs) in the pediatric patients. Methods: All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study. Results: A total of 66 patients (median age: 3.93 years, median weight: 15 kg) underwent attempted TCC of CCFs. Immediate successful device implantation was achieved in 62 patients, and immediate complete occlusion was achieved in 44 patients (44/62%, 71.0%). The closure procedure was waived in 2 patients due to anatomical factors. A total of 6 periprocedural complications occurred in 5 patients, including acute myocardial infarction (n = 3), procedure-related death (n = 1), device embolization (n = 1), and rupture of tricuspid chordae tendineae (n = 1). The acute procedural success rate was 89.4% (59/66), while the acute complication rate was 9.1% (6/66). Follow-up data were collected for 58 (93.5%) out of 62 patients at a median of 9.3 years (range: 3.0–15.7 years). 10 adverse events occurred in 9 patients, including 5 follow-up complications (1 aortic valve perforation, 1 coronary thrombosis, 1 progressive aneurysmal dilation after reintervention, and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation), and 5 closure failure with large residual shunts. The intermediate and long-term adverse event rate was 17.2% (10/58). The anatomical features associated with both acute and follow-up adverse events were large CCFs (p = 0.005), and giant coronary artery aneurysms (CAAs) (p = 0.029). Conclusions: TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate. Large CCFs and giant CAAs represent a higher risk of both acute and intermediate and long-term adverse events after closure.

---

Keywords

---