Evaluation Of Single Center Spring-Loop Closure For Coronary Pulmonary Fistula Treatment

Objective: to analyze the change of preoperative postoperative related examination indexes and symptoms in patients undergoing coronary-pulmonary artery fistula(CPAF)spring-coil embolization surgery,meanwhile,to analyze the results of reexamination between the surgical group and the nonsurgical group,and to evaluate the therapeutic efficacy and safety of using spring-coil embolization for coronary pulmonary artery fistula in patients.Methods: We retrospectively reviewed the relevant clinical data of 54 patients with coronary-pulmonary artery fistula who visited the Department of Cardiology of Zhejiang Provincial People’s Hospital from March 2013 to November 2020,and all of them had undergone coronary angiography to confirm the disease.Among them,25 patients were treated with spring-loop embolization fistula after the consent of patients and family members,and all confirmed patients were followed up by postoperative review to observe the change of examination indexes and symptoms.Results: in total,54 patients with CPAF underwent coronary angiography to confirm the diagnosis of coronary pulmonary fistula,including 30 male patients and 24 female patients.All patients had well-established ECG,chest CT,cardiac ultrasound and other relevant examinations before contrast,and coronary angiography suggested a single vessel origin in 36(66.67%)of all 54 patients,two vessel origin in 14(25.93%)and three vessel origin in 4(9.26%)patients.There were 25 patients(46.30%)with right coronary artery origin,33 patients(61.11%)with left anterior descending artery origin,3 patients(5.56%)with left circumflex artery origin and 5 patients(9.26%)with left main coronary artery origin.Of the 25 patients who elected to undergo surgical closure of their fistulas with coil embolization after discussion with the patient himself and family members,2 had failed surgical closure due to failure of the guide wire to reach the fistula,and the remaining 23 had successful surgery with an average of implanted spring coils(4.43 ± 3.06 ±).There were no significant associated surgical complications or deaths in any of the operated patients postoperatively and on review.All 54 CPAF patients had relevant complaints on review at the outpatient clinic6-12 months later,and 19 of 31 CPAF patients who did not have a spring-loop closure fistula or failed the procedure still had relevant complaints on review.Seventeen of the23 patients who underwent coil embolization had significant improvement or disappearance of self-reported symptoms compared with before,3 patients had a small amount of residual fistula on postprocedural hyper-or coronary angiogram re examination,overall postprocedural patients had some improvement in cardiac function,and left ventricular ejection fraction(56.09 ± 8.97)compared with patients who underwent coil embolization,Postoperative LVEF(60.13 ± 7.41),the results were statistically different(p < 0.5).Conclusion: CPAF patients undergoing coil closure had some degree of improvement in symptoms,cardiac function,and EF compared with the preoperative period,which also compares favorably with CPAF patients in the nonsurgical group,all of whom had no relevant surgical complications or deaths postoperatively.Spring coil closure of coronary-pulmonary artery fistula is a safe and effective surgical procedure,which can significantly improve the quality of life and reduce the occurrence of patient related complications.