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Congenital coronary artery fistulas. Diagnostic and surgical considerations
H Y Karagoz1, Y I Zorlutuna, K M Babacan
1Department of Cardiovascular Surgery, Higher Specialization Hospital, Ankara, Turkey.
Insights
Surgical repair of congenital coronary artery fistulas is effective, with no operative mortality and excellent long-term outcomes. This approach prevents serious complications in patients with these heart conditions.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Thoracic Surgery
Background:
- Congenital coronary artery fistulas are rare anomalies.
- Patients may present with symptoms like congestive heart failure or angina, or be asymptomatic.
- Surgical intervention is considered for management.
Purpose of the Study:
- To evaluate the surgical outcomes for patients with congenital coronary artery fistulas.
- To assess the safety and efficacy of different surgical techniques.
Main Methods:
- Retrospective review of 9 patients who underwent surgical repair between 1974 and 1988.
- Analysis of patient demographics, fistula origin and termination, surgical approach (with or without cardiopulmonary bypass), and outcomes.
- Long-term follow-up assessment.
Main Results:
- Nine patients (4 female, 5 male; age 6-50 years) underwent surgical repair.
- Fistula origins varied, with common terminations in the pulmonary artery (6 patients).
- No operative mortality was observed; 8 of 9 patients remained asymptomatic during a mean follow-up of 5.4 years.
Conclusions:
- Surgical therapy for congenital coronary artery fistulas is recommended to prevent complications.
- Closure from the involved chamber is a suggested technique when cardiopulmonary bypass is necessary.
- Excellent long-term results support surgical intervention for this condition.
Abstract:
Between 1974 and April, 1988, 9 patients with congenital coronary artery fistulas underwent surgical repair. Of these, 4 were female and 5 male, ranging in age from 6 to 50 years (mean 28.2 +/- 18.9). Seven patients were symptomatic (congestive heart failure and/or angina), whereas in 2 patients the diagnosis was established through the investigation of an asymptomatic continuous murmur. The origin of the fistula was the left main coronary artery in 1, left anterior descending artery (LAD) in 2, circumflex artery (Cx) in 3, Cx + LAD in 2 and LAD + right coronary artery in 1 patient. The sites of termination of the fistulous tract were the pulmonary artery in 6, the right atrium in 1, the right ventricle in 1 and the left ventricle in 1 patient. In 2 cases the fistulous tracts were ligated without utilizing cardiopulmonary bypass (CPB). In 7 cases CPB was instituted and in 6 of these the fistulous communications were closed from within the termination chamber, in 1 patient the fistula was closed through a coronary arteriotomy during elective ventricular fibrillation. There was no operative mortality and long term follow-up was uneventful after a mean follow-up of 5.4 +/- 5.2 years, with 8 patients still completely asymptomatic. Surgical therapy is recommended for patients having coronary artery fistulas in order to prevent fistula-related complications. In those cases requiring CPB, closure of the fistula from the involved chamber only is suggested.