Intermediate and Long-Term Follow-Up of Transcatheter Closure of Congenital Coronary Cameral Fistulas in Infants and Children: Experience from a Single Center

Background: Limited data are available regarding intermediate and long-term outcomes of transcatheter closure (TCC) of coronary cameral fistulas (CCFs) in the pediatric patients. Methods: All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study. Results: A total of 66 patients (median age: 3.93 years, median weight: 15 kg) underwent attempted TCC of CCFs. Immediate successful device implantation was achieved in 62 patients, and immediate complete occlusion was achieved in 44 patients (44/62%, 71.0%). The closure procedure was waived in 2 patients due to anatomical factors. A total of 6 periprocedural complications occurred in 5 patients, including acute myocardial infarction (n = 3), procedure-related death (n = 1), device embolization (n = 1), and rupture of tricuspid chordae tendineae (n = 1). The acute procedural success rate was 89.4% (59/66), while the acute complication rate was 9.1% (6/66). Follow-up data were collected for 58 (93.5%) out of 62 patients at a median of 9.3 years (range: 3.0-15.7 years). 10 adverse events occurred in 9 patients, including 5 follow-up complications (1 aortic valve per-foration, 1 coronary thrombosis, 1 progressive aneurysmal dilation after reintervention, and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation), and 5 closure failure with large residual shunts. The inter-mediate and long-term adverse event rate was 17.2% (10/58). The anatomical features associated with both acute and follow-up adverse events were large CCFs (p = 0.005), and giant coronary artery aneurysms (CAAs) (p = 0.029). Conclusions: TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate. Large CCFs and giant CAAs represent a higher risk of both acute and inter-mediate and long-term adverse events after closure.