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Surgical treatment of coronary artery fistulas: 15 years' experience
Ufuk Demirkilic1, Ertugrul Ozal, Hakan Bingol
1Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey. udemirkilic@gata.edu.tr
Insights
Surgical treatment of coronary artery fistulas had no operative mortality. Postoperative electrocardiographic changes in patients with coronary artery fistulas can be transient and require repeat angiography to rule out coronary artery damage.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery fistulas are abnormal connections between a coronary artery and a heart chamber or major vessel.
- Surgical correction is a treatment option for coronary artery fistulas.
Purpose of the Study:
- To report the experience of surgical treatment for coronary artery fistulas.
- To analyze postoperative electrocardiographic changes following surgical correction.
Main Methods:
- Retrospective review of 21 patients undergoing cardiac operations for coronary artery fistula between 1988 and 2003.
- Analysis of electrocardiographic changes and outcomes, including repeat coronary angiography when indicated.
Main Results:
- No operative mortality was observed in 21 patients.
- Two patients (10%) experienced transient, nonspecific electrocardiographic changes postoperatively.
- Repeat angiography confirmed normal coronary anatomy in affected patients, with electrocardiogram normalization within 2 months.
Conclusions:
- Surgical treatment of coronary artery fistulas is safe with no operative mortality.
- Postoperative electrocardiographic abnormalities in these patients are often transient.
- Patients with suspected myocardial ischemia post-surgery require repeat angiography to exclude coronary artery damage.
Abstract:
We report our experience of surgical treatment of coronary artery fistula and focus on the electrocardiographic changes that may be seen postoperatively. Between 1988 and 2003, cardiac operations were carried out on 9,487 patients, of whom 21 had a coronary artery fistula. The mean age of these 21 patients was 36.8 +/- 4.9 years. The fistula originated from the right coronary artery in 9 cases and from the left side in 12. The fistulous connection was to the right ventricle in 5 patients, to the right atrium in 6, to the pulmonary artery in 8, and to the coronary sinus in 2. There was no operative mortality. Two patients (10%) had nonspecific electrocardiographic changes during the postoperative period. Repeat coronary angiography revealed normal coronary anatomy in both, and their electrocardiograms normalized within 2 months. Patients suspected to have myocardial ischemia related to the surgical procedure, with ST segment depression or T wave abnormalities on the electrocardiogram, should undergo repeat angiography to eliminate the possibility of coronary artery damage.
