Three-Decade Experience With Management of Coronary Artery Fistulas in Children
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".