Coronary Interventions in Pediatric Congenital Heart Disease

Objectives: Coronary lesions represent a rare condition in pediatric congenital heart disease and mainly include coronary artery stenoses and coronary fistulae.

Methods: In this retrospective single-center study, we analyzed indications, procedural details and postprocedural outcomes in pediatric patients with congenital heart disease who underwent coronary interventions in our institution. For the treatment of coronary stenoses, procedural success was defined as efficient coronary revascularization with a significant improvement of coronary perfusion/lumen gain. Treatment of coronary fistulae was considered successful, when no residual shunt was detectable.

Result: From January 1995 to August 2020, 32 pediatric patients aged ≤18 years received interventional treatment for coronary stenoses (n = 24/32, 75.0%) and coronary fistulae (n = 8/32, 25.0%). Reasons for coronary artery stenoses were postsurgical (n = 13/24, 54.2%), posttransplant (n = 9/24, 37.5%), postinterventional (n = 1/24, 4.2%), and presence of a myocardial bridge (n = 1/24, 4.2%). Treatment of coronary stenoses included 33 percutaneous transluminal coronary angioplasties and 25 stent placements (drug-eluting stent: n = 24 and bioresorbable stent: n = 1). Procedural success was achieved in 24 of 25 patients (96.0%). Despite the high-procedural success rate, however, in-hospital mortality occurred in 6 of 24 patients (25.0%) and late mortality in 5 of 24 patients (20.8%) leading to an overall 5-year survival probability of 62.5% after treatment of coronary stenoses. Differential pattern of coronary fistulae were seen: left anterior descending artery (LAD) to right ventricle (n = 4/8, 50.0%), right coronary artery (RCA) to right atrium (n = 3/8, 37.5%), and circumflex artery (CX) to right ventricle (n = 1/8, 12.5%). Closure of coronary fistulae was performed using coil embolization (n = 3), placement of vascular plugs (n = 3), and a combination of both (n = 1) or a combination of coil embolization and a covered stent (n = 1). Treatment of coronary fistulae was successful in all patients (100.0%). To date, no in-hospital or follow-up death occurred in this patient cohort.

Conclusion: Coronary interventions in pediatric patients with congenital heart disease can be performed safely and effectively. However, the overall 5-year survival probability of patients with coronary stenoses is reduced.

Publication History

Article published online:
21 February 2021