Coronary artery fistulas (CAFs) are rare congenital coronary anomalies in children and are frequently detected incidentally; however, the optimal management of asymptomatic cases and long-term outcomes remain debated. We retrospectively evaluated patients <18 years who underwent cardiac catheterization and coronary angiography for CAF at a single tertiary center between 2003 and 2022, analyzing demographic, clinical, angiographic, procedural, and follow-up data; fistulas were classified using a modified Sakakibara system, and temporal changes in institutional clinical approach and device selection were also assessed. Forty-two patients (mean age 7.4 ± 5.9 years) were included, most of whom were asymptomatic (80.9%); the left coronary artery was the most frequent origin and 85% drained to right-sided chambers. Transcatheter closure was attempted in 25 patients and was technically successful in 23 (92%); complete occlusion was achieved angiographically in 61% immediately and exceeded 90% during follow-up due to spontaneous resolution of residual shunts. One patient required surgery for persistent moderate residual flow, and no major procedural complications, thrombotic events, or ischemic outcomes were observed. In selected children, transcatheter CAF closure is safe and effective, while conservative follow-up appears appropriate for small, hemodynamically insignificant fistulas, supporting individualized, anatomy-guided management.
Aykan et al. (Thu,) studied this question.