Single Center Retrospective Evaluation of Coronary Artery Fistula Outcomes

There is a paucity of literature describing long-term outcomes of patients with coronary artery fistula with most manuscripts focusing on those requiring interventions. We describe single-center outcomes of coronary artery fistulas including those not requiring intervention. We performed a retrospective review of the electronic medical record and identified all patients with a diagnosis of coronary artery fistula over the last 10 years. 158 patients were identified with a coronary artery fistula. The mean age at diagnosis was 5.8 years (SD ± 5.9). There was a male (55%, n = 87) predominance. Concomitant congenital heart lesion was present in 49% (n = 77) and a genetic anomaly was found in 18% (n = 29). No ischemic changes on electrocardiogram or ECG-stress test were observed. The mean follow-up was 5.0 (SD ± 3.8) years. Most patients (94%, n = 149) did not undergo an intervention. Of those 63% (n = 94) had at least one follow-up echocardiogram. There was spontaneous coronary artery fistula closure in 44% (n = 41), 8% (n = 8) decreased in size, and 48% (n = 45) were unchanged. No patient had enlargement of the coronary artery fistula over time. Additionally, tiny and small coronary artery fistulas showed no significant clinical changes in coronary artery dimensions, left ventricle dimensions and function over time. Seven patients required intervention; two patients underwent surgical ligation and five underwent catheter-based intervention. Most patients with coronary artery fistula in our cohort did not require intervention and over half either closed spontaneously or decreased in size with routine follow-up.