Original Article Transcatheter Embolisation of Coronary Artery Fistulae Robert N. Justo, MBBS, FRACP, Richard E. Slaughter, MBBS, FRACR, Christopher M. Whight, MBBS, FRAU and Dorothy J. Radford, MD, FRACP The Queensland Centre for Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia Background: Most children with coronary artery fistulae are asymptomatic, but because of associated late morbidity, early intervention is usually indicated. Aim: To assess the outcome following transcatheter embolisation of coronary artery fistulae. Patients and Methods: Six children, with a median age of 9.5 years (range: 1.3-13.7 years), underwent transcatheter embolisation of coronary artery fistulae. Four patients had simple fistulae, which drained from the right coronary artery to the right ventricle (n = 2), the left coronary artery to the right ventricle (n = l), or the left coronary artery to the coronary sinus (n = 1). Two patients had complex multiple fistulae arising from both coronary arteries, which communicated with either the right ventricle or the pulmonary arterial system. Results: A stable position with a 5-Fr coronary catheter was obtained proximally and a 3-Fr coaxial catheter was advanced through the coronary catheter to a distal position in the coronary artery fistulae. The number of embolisation microcoils used per procedure ranged from one to 12, and the coil diameter ranged from 3 mm. Polyvinyl alcohol foam embolisation particles (1000 pm) were used to embolise small fistulae to the pulmonary arterial tree. Complete occlusion was obtained in four patients, while two children were left with insignificant residual shunts. There were no early or late cardiac complications. Conclusion: Transcatheter embolisation of coronary artery fistulae is a safe and effective therapy in patients with suitable anatomy. (Heart, Lung and Circulation 2001; 10: 53-57) Key words: coronary artery fistulae, interventional cardiology, paediatric cardiology. E arly elective treatment of coronary artery fistulae, even in the asymptomatic patient, is recom- mended because of the documented occurrence of late complications such as chronic cardiac volume over- load (fatigue, palpitation, dyspnoea, heart failure), angina pectoris (due to either atherosclerotic coronary artery disease or ‘coronary steal’), aneurysmal dilatation and end0carditis.l” While surgical treatment of coronary artery fistulae has been shown to be a safe and effective Correspondence: Robert N. Justo, The Prince Charles Hospital, Rode Road, Brisbane, Queensland 4032, Australia. Email: robert-justoQhealth.qld.gov.au treatment,4,5 late surgical intervention is associated with increased morbidity at the time of the interventi0n.l Transcatheter embolisation of coronary artery fistulae was first described in 1991,6 and has increasingly become the treatment of choice for anatomically suitable lesions.7-11 We report our initial experience in a paedi- atric population. Methods Between January 1997 and November 1999, six patients diagnosed with coronary artery fistulae underwent car- diac catheterisation. Clinical features of these patients