Closure of coronary arteriovenous fistula (CAVF) is the procedure used to treat abnormal connections in the heart’s vascular system between coronary arteries and venous structures. These fistulas can either be congenital or acquired later in life due to trauma, surgical procedures, or infections. This condition disrupts the normal circulation of blood by allowing it to flow directly from coronary arteries into the venous system.

What is Coronary Arteriovenous Fistula (CAVF)?

CAVF is an abnormal connection between coronary arteries and the venous system. While often present from birth, it can also develop following trauma, surgical procedures, or infections. This abnormal connection increases the heart’s workload, leading to various symptoms and potentially severe cardiac problems over time.

Symptoms

• Chest pain
• Shortness of breath
• Heart palpitations
• Fatigue
• Symptoms of heart failure

Procedure for CAVF Closure

CAVF closure is performed using angiography and catheter-based minimally invasive techniques. Typically conducted in a cardiac catheterization laboratory, the procedure involves several steps:

Preparation and Anesthesia:

• The procedure is usually performed under local anesthesia and sedation.
• Medications and fluids are administered through the patient’s vascular access, and necessary monitoring is ensured.

Catheter Insertion:

• A catheter is inserted via the femoral artery or vein and guided into the coronary vascular system.
• Angiography is performed to evaluate the location, size, and anatomy of the fistula.

Placement of Closure Device:

• A suitable closure device (such as a coil, Amplatzer device, or stent) is inserted through the catheter to the fistula site.
• The closure device seals the fistula, thereby stopping abnormal blood flow.
• Confirmation of correct positioning and successful closure is verified using echocardiography or angiography.

Monitoring and Catheter Removal:

• Post-procedure, the success of the procedure is assessed.
• The catheter is carefully removed, and the insertion site is closed.

Advantages of the Procedure

• Minimally Invasive: Less invasive compared to open-heart surgery, resulting in shorter recovery times.
• Quick Recovery: Patients can typically be discharged shortly after the procedure and resume normal activities quickly.
• Lower Risk of Complications: Minimally invasive methods reduce the risk of complications such as infection and bleeding.
• Effective Symptom Control: Halting abnormal blood flow quickly reduces symptoms and improves heart function.

Risks of the Procedure

Like any medical procedure, CAVF closure carries risks and potential side effects, including:

• Bleeding and Infection: Risk at the catheter insertion site.
• Arrhythmia: Development of arrhythmia or other rhythm disturbances post-procedure.
• Device-Related Complications: Risk of device migration or inadequate closure.
• Thrombosis: Possibility of blood clot formation during fistula closure.

Post-Procedural Follow-up and Care

After the procedure, patients should attend regular follow-up appointments to monitor heart function. Medications (such as anticoagulants or antiarrhythmics) should be taken as prescribed, and lifestyle changes recommended by the doctor (such as healthy eating and regular exercise) should be implemented. Participation in cardiac rehabilitation programs may also be recommended to improve heart function and alleviate symptoms.

Conclusion

Closure of coronary arteriovenous fistula is an effective and safe treatment option for patients with CAVF. When performed by experienced cardiologists and interventional radiologists, this method can significantly improve patients’ quality of life and reduce the risk of serious complications. However, determining the appropriate treatment method for each patient requires comprehensive evaluation and risk analysis.