Assistant Professor of Pediatric Cardiology, Shahrekord University of Medical Sciences
Associate Professor of Pediatrc Cardiology, Shaheed Rajaie Cardiovascular Medical Center
Associate Professor of Pediatrc Cardiology , Dr. Shariati Hospital, Tehran University of Medical Sciences
Background- Coronary artery fistula (CAF) is a rare congenital anomaly that can be complicated by endocarditis, myocardial infarction or coronary aneurysms. The purpose of this article is to review the clinical characteristics and surgical outcome in 10 patients with CAF.
Methods- From 1990 to 2000, ten patients (aged 6 months to 15 years with a mean of 8.5 years) were diagnosed with CAF via echocardiography and cardiac catheterization. Six were female and 4 were male. All the patients with isolated CAF (9) were asymptomatic. One patient with associated anomaly (MVP with severe MR) had dyspnea on exertion and palpitation.
Results- Five fistulas originated from the right coronary artery, three from the left and two from the left circumflex. Drainage was to the right ventricle (7), right atrium (2) and pulmonary artery (1). The ratio of pulmonary to systemic flows ranged between 1 to 1.6. All the patients had surgical ligation. In the symptomatic patient, in addition to ligation, mitral valve replacement was performed. There was no operative or late death. Follow-up evaluation ranging from 1 year to 6 years with a mean of 4.2 years showed no evidence of recurrent or residual CAF.
Conclusion- Surgical management of CAF is a safe and effective treatment, resulting in 100% closure rate (Iranian Heart Journal 2003; 4 (4):35-38).