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Outcomes of surgical repair of pediatric coronary artery fistulas

Published byFrancisco Cruz Segura Modified over 5 years ago

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Presentation on theme: "Outcomes of surgical repair of pediatric coronary artery fistulas"— Presentation transcript:

1 Outcomes of surgical repair of pediatric coronary artery fistulas
Wen Zhang, MD, Renjie Hu, MD, Lei Zhang, MD, Hongbin Zhu, MD, Haibo Zhang, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 152, Issue 4, Pages e1 (October 2016) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Catheter angiography demonstrating anatomic characteristics of the CAF. A, RCA is enlarged and gives rise to branches before terminates at the RV. B, LCX is extremely tortuous along its route to the RV. C, Fistula from both RCA and LCA to RV. The drainage sites of both fistulae are very close to each other. D, RCA is enlarged with an aneurysm at the middle portion. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Intraoperative images showing the transcameral closure technique. A, Identification of the fistula orifice inside the RV through the right atrium and tricuspid valve. B, The fistula is closed by suture ligation with pads. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Kaplan–Meier analysis of the incidence of freedom from residual shunt after surgery. The shaded area indicates 95% confidence limits. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Catheter angiography and transcatheter closure for the residual shunt. The first patient: (A) Two aneurysmal dilations of the left anterior descending artery are identified connected by an isthmus portion (arrow), before entry into the apex of the RV (arrowhead). B, The residual shunt is obliterated by placing an Amplazter PDA occluder (AGA Medical Corp, Golden Valley, Minn) between the aneurysms. The second patient: (C) The dilated LCX artery drains into the RV (arrow). D, An Amplazter vascular plug (arrow) is placed distal to the coronary, but a trivial leak is identified after the procedure. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure E1 Example of an RCA to right atrium fistula detected by multidetector computed tomography with maximum intensity projection reconstruction. A, Dilation of the RCA with a diameter of 7.3 mm at the origin. B, The enlarged RCA travels along the right atrioventricular groove. C, The RCA terminates in the RA with a diameter of 5.2 mm. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Freedom from residual shunt after surgical repair is shown.
The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 Video 1 Transcameral closure of CAF. This was a 3-year-old boy with an RCA to RV fistula. Preoperative cardiac catheterization demonstrated that the RCA gave rise to small branches before terminating at the RV. Transcameral closure of the fistula was performed via a median sternotomy. CPB was performed via aortobicaval cannulation. Aortic crossclamping and cardioplegia were used. The fistula orifice was identified by RV exposure through the right atrium and tricuspid valve. The fistula was confirmed by delivery of cardioplegic solution. The fistula was closed by direct suture with pads. Successful closure was confirmed by administering methylene blue in cardioplegia. No residual shunt was identified on intraoperative transesophageal echocardiography. Video available at The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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