Transcatheter Embolization of Congenital Coronary Arteriovenous Fistula

Between March, 1994, and J anuary, 2001, transcatheter fistula oc cl usion procedure w as performed in five children with the diagnosis of congenital coronary arteriovenous fistula in whom median age was 5.3 years (range 0.7 to 11.0). Surgical ligation procedure had been performed in one of these patients, but recanalization occurred during follow-up. Dilation of the feeding coronary artery of the fistula, due to increased blood flow, was observed in four of the patients. There was an additicnal aneurysmal sac formatian of the coromı.ry artery in one of these. Occlusion attempt was performed three times in one patient, twice in two patients and once in the other two. Detachable balloon was used for occluding the fistula in two patients and release control coils in the others. Complete occlusion of the fistula was achieved in four of the patients. In the last patient with normal coronary artery diameter, complete occlusion of the fistula was also achieved, which was at the distal end of left anterior descending artery; but attempts for the second one at the distal end of second diagonal artery was unsuccessful. Mild/moderate aortic valve insufficiency developed in this patient due to catheter manipulations for catheterizing this fi stula. As minor complication, femoral artery thrombosis developed in one patient, which was resolved with heparİn infusion. Our experience shows that transcatheter occlusion of congenital coronary arteriovenous fistula is feasible if proper occlusion technique is selected in each case.