[Surgical treatment of coronary artery fistulas]

Coronary artery fistula is one of the most common coronary malformations and is being diagnosed with increasing frequency with widespread use of selective coronary arteriography. Twenty-one patients with coronary artery fistulas underwent surgical treatment at our institute between 1973 and 1994. The left coronary artery was most commonly involved, and the fistula communicated primarily with the pulmonary artery. Associated cardiovascular disease include: mitral stenosis (1), mitral insufficiency (1), partial anomalous pulmonary venous return (1), ventricular tachycardia (1), atrial septal defect (1), aortitis syndrome (1), and coronary arteriosclerotic narrowing (1). In five patients, the coronary artery fistulas were selectively ligated without CPB. In sixteen patients, in addition to selective ligation, the fistula ostia were closed from inside using CPB. There were no operative or late deaths in the patients who underwent operations. Thus, the risks of surgical correction appear to be considerably less than the potential development of serious and possibly fatal complications, even in asymptomatic patients.