Clinical outcomes of transcatheter closure of congenital coronary artery fistula in 28 cases

Most cases of congenital coronary artery fistula (CAF) resolve spontaneously, symptomatic patients with severe shunting require surgical intervention. Our aim is to evaluate success rate and outcome of CAFs treatment using transcatheter interventional methods. This retrospective study conducted on 28 CAF patients who were referred to Rajaie Cardiovascular Medical and Research Center in Tehran between 2015 and 2020. Baseline characteristics were collected by assessing hospital records, and patients were followed up annually for long-term evaluation. All of 28 patients gone through transcatheter closure of CAF. In 23 patient's it was proximal type (82.1%) and in 5 patients was distal type (17.9%). In 11 patients, the fistula originated from the RCA (39.3%) and in 11 patients, it originated from the LAD and Diagonal. Most common drainage site was the pulmonary artery (82.1%). Coil used in 23 patients(82.1%). PDA occluder (7.1%) for 2 patients. VSD occluder for one patient (3.6%) and VSD+PDA occluder combination was used for one patient (3.6%). Procedure failure was in only one patient. Non-significant remaining shunt in the injection immediately after the procedure was seen in 4 patients (14.3%), which was reduced during the follow-up. None of the patients had significant shunt or clinical symptoms during long-term follow-up. As for complications, fistula dissection occurred in only one patient. The transcatheter interventional approach for the treatment of CAFs leads to favorable long-term results.