TY - JOUR
T1 - Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae
AU - Valente, Anne Marie
AU - Lock, James E.
AU - Gauvreau, Kimberlee
AU - Rodriguez-Huertas, Elizabeth
AU - Joyce, Caitlyn
AU - Armsby, Laurie
AU - Bacha, Emile A.
AU - Landzberg, Michael J.
PY - 2010/4
Y1 - 2010/4
N2 - Background:Significant morbidities, including angina, symptomatic heart failure, and myocardial infarction, have been reported after coronary artery fistula (CAF) closure; however, predictors that may be associated with adverse outcomes have not been established. The goal of this investigation is to describe the long-term outcomes witnessed in patients with either treated or untreated CAF at our institution and to investigate whether certain features predicted adverse outcomes. Methods and Results:The records and angiograms of patients with CAF who underwent a diagnostic cardiac catheterization at Children's Hospital Boston from 1959 through 2008 were reviewed. Of 76 patients identified, 20% were associated with additional congenital heart disease. Forty-four underwent transcatheter closure, 20 underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Three patients who had initially undergone surgical closure had a second intervention, 1 underwent repeat surgery, and 2 underwent transcatheter closure. One patient who had undergone transcatheter closure underwent a second transcatheter closure for residual fistula. Major complications, including myocardial infarction, angina with coronary thrombosis, and symptomatic cardiomyopathy, occurred in 11 (15%) patients. The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus (P<0.001). Clinical predictors associated with adverse outcomes included older age at diagnosis (P<0.001), tobacco use (P=0.006), diabetes (P=0.05), systemic hypertension (P<0.001), and hyperlipidemia (P<0.001). Conclusions:Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction, and cardiomyopathy. CAF that drain into the coronary sinus are at particularly high-risk of long-term morbidities after closure, and strategies including long-term anticoagulation should be considered.
AB - Background:Significant morbidities, including angina, symptomatic heart failure, and myocardial infarction, have been reported after coronary artery fistula (CAF) closure; however, predictors that may be associated with adverse outcomes have not been established. The goal of this investigation is to describe the long-term outcomes witnessed in patients with either treated or untreated CAF at our institution and to investigate whether certain features predicted adverse outcomes. Methods and Results:The records and angiograms of patients with CAF who underwent a diagnostic cardiac catheterization at Children's Hospital Boston from 1959 through 2008 were reviewed. Of 76 patients identified, 20% were associated with additional congenital heart disease. Forty-four underwent transcatheter closure, 20 underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Three patients who had initially undergone surgical closure had a second intervention, 1 underwent repeat surgery, and 2 underwent transcatheter closure. One patient who had undergone transcatheter closure underwent a second transcatheter closure for residual fistula. Major complications, including myocardial infarction, angina with coronary thrombosis, and symptomatic cardiomyopathy, occurred in 11 (15%) patients. The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus (P<0.001). Clinical predictors associated with adverse outcomes included older age at diagnosis (P<0.001), tobacco use (P=0.006), diabetes (P=0.05), systemic hypertension (P<0.001), and hyperlipidemia (P<0.001). Conclusions:Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction, and cardiomyopathy. CAF that drain into the coronary sinus are at particularly high-risk of long-term morbidities after closure, and strategies including long-term anticoagulation should be considered.
KW - Complication
KW - Congenital
KW - Coronary disease
KW - Fistula
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U2 - 10.1161/CIRCINTERVENTIONS.109.883884
DO - 10.1161/CIRCINTERVENTIONS.109.883884
M3 - Article
C2 - 20332380
AN - SCOPUS:77953672645
SN - 1941-7640
VL - 3
SP - 134
EP - 139
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 2
ER -