Percutaneous approaches to closure of coronary artery fistulas

Coronary artery fistula (CAF) is the most common hemodynamically significant congenital coronary anomaly. Blood is shunted from the coronary artery to a cardiac chamber, vein or intrathoracic vessel, bypassing the myocardial capillary network. The majority of the fistulas are small, and are detected incidentally and do not require intervention. The natural history of a CAF is variable and even spontaneous closure may be detected in rare cases. Treatment of CAF is indicated for symptomatic patients and for those asymptomatic patients with significant shunt or large fistulas that create risk for future complications, such as infective endocarditis, pulmonary hypertension or heart failure. Traditionally, surgery has been the main therapeutic method for the closure of CAF with proven efficacy and safety. However, since the first report of the use of percutaneous intervention in CAFs, many investigators have reported successful results using several techniques. Recent developments in the percutaneous closure m...