Three-Decade Experience With Management of Coronary Artery Fistulas in Children
Notice bibliographique
Résumé
BackgroundTreatment approach of coronary artery fistulas (CAFs) is debatable and long-term outcomes are unknown.MethodsRetrospective institutional data review of children in whom echocardiographically suspected CAFs were confirmed during cardiac catheterization from 1997-to-2023. Treatment approach and outcomes were assessed.ResultsWe identified 94 CAFs in 78 patients (42.3% males), median age of 3.4 years (IQR, 0.9-6.6). 25 (32%) patients had other congenital anomalies. 41/52 (78.8%) patients with isolated CAFs were asymptomatic. Most common site of CAF origin and drainage was the left system (62.8%) and right cardiac cavities (80.8%). Overall median follow-up was 101 months (IQR, 41-185). 23 (29.5%) patients with 35 (37.2%) small or non-shunting CAFs had conservative management and 20/23 (87%) patients had an uneventful follow-up. 8 (10.2%) patients with 9 (9.6%) complex CAFs were directly sent for surgery. One had early surgical patch failure needing surgical reintervention. 47 (60.3%) patients had catheter closure of 50 (53.2%) medium or large-sized CAFs using coils (30%), vascular plugs (20%), Nitinol duct occluders (40%), or material combination (10%). Six serious complications occurred. 2/3 patients with unsuccessful catheter procedures had subsequent surgeries. 2/3 patients with mild shunts had successful redo closures. One asymptomatic patient had recanalization after 12 years and is under watchful observation.ConclusionsCAFs have various anatomies and clinical presentations. Transcatheter closure is effective in carefully selected patients but is not complication-free. Surgery is a valuable upfront option in complex CAFs or bailout of unsuccessful transcatheter closures even though not frequently used. Treatment approach of coronary artery fistulas (CAFs) is debatable and long-term outcomes are unknown. Retrospective institutional data review of children in whom echocardiographically suspected CAFs were confirmed during cardiac catheterization from 1997-to-2023. Treatment approach and outcomes were assessed. We identified 94 CAFs in 78 patients (42.3% males), median age of 3.4 years (IQR, 0.9-6.6). 25 (32%) patients had other congenital anomalies. 41/52 (78.8%) patients with isolated CAFs were asymptomatic. Most common site of CAF origin and drainage was the left system (62.8%) and right cardiac cavities (80.8%). Overall median follow-up was 101 months (IQR, 41-185). 23 (29.5%) patients with 35 (37.2%) small or non-shunting CAFs had conservative management and 20/23 (87%) patients had an uneventful follow-up. 8 (10.2%) patients with 9 (9.6%) complex CAFs were directly sent for surgery. One had early surgical patch failure needing surgical reintervention. 47 (60.3%) patients had catheter closure of 50 (53.2%) medium or large-sized CAFs using coils (30%), vascular plugs (20%), Nitinol duct occluders (40%), or material combination (10%). Six serious complications occurred. 2/3 patients with unsuccessful catheter procedures had subsequent surgeries. 2/3 patients with mild shunts had successful redo closures. One asymptomatic patient had recanalization after 12 years and is under watchful observation. CAFs have various anatomies and clinical presentations. Transcatheter closure is effective in carefully selected patients but is not complication-free. Surgery is a valuable upfront option in complex CAFs or bailout of unsuccessful transcatheter closures even though not frequently used.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».