Document Detail


Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae.
MedLine Citation:
PMID:  20332380     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Anne Marie Valente; James E Lock; Kimberlee Gauvreau; Elizabeth Rodriguez-Huertas; Caitlyn Joyce; Laurie Armsby; Emile A Bacha; Michael J Landzberg
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-23
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  3     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-21     Completed Date:  2010-09-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-9     Citation Subset:  IM    
Affiliation:
Boston Adult Congenital Heart Program, Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. anne.valente@cardio.chboston.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Factors
Aged
Arterio-Arterial Fistula / congenital,  diagnosis*,  pathology,  physiopathology,  therapy
Child
Child, Preschool
Coronary Angiography
Coronary Thrombosis / etiology*
Coronary Vessels / pathology*,  surgery
Drainage
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Middle Aged
Myocardial Infarction / etiology*
Postoperative Complications*
Smoking
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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