Clinical analysis of 21 patients with congenital coronary artery fistula

Abstract

Objective To investigate the experiences in the treatment of congenital coronary artery fistula(CAF). Methods The clinical data of 21 patients with CAF who were admitted to Qilu Hospital of Shandong University from December 2005 to April 2014 were retrospectively analyzed. There were 12 males, 9 females, their age ranged from 2 months to 74 years old, with a mean age of 27.8 years. All patients performed echocardiography to confirm the fistula, or diagnosed by coronary angiography. Thirteen patients underwent surgical repair with cardiopulmonary bypass (CPB), 3 patients underwent transcatheter closure, and the other 5 patients were treated conservatively. Results No severe cerebral or cardiac complications were found during the perioperative period. The operation went smoothly in all 16 surgery patients, pulmonary hypertension crisis occurred in one case combined with patent ductus arteriosus, and 1.5 mm residual shunt was found in one patient. Fifteen patients of surgery and five patients with conservative treatment drugs were followed up for 0.7 to 9 years, average of 3.9 years. Fifteen surgery patients had no severe procedure-related complications, and no symptoms of the CAF during the follow-up period. Echocardiography confirmed that 15 patients underwent surgical and transcatheter closure abnormal shunts were disappeared. One patient, 1.5 mm residual fistula was healed, aneurysmal dilatation occurred in the proximal fistula in one patient. In 5 asymptomatic cases, no related complications occurred, 2 patients underwent spontaneous closure, the fistula diminished in 1 patient, no significant change was observed in two other cases. Conclusions The surgical and transcatheter closure of CAF is safe and efficient, it is possible that congenital coronary artery fistula can achieve spontaneous healing through conservative treatment once the fistula is no bigger than 4 mm, the patient is asymptomatic, no more other associated cardiac abnormalities are combined. Key words: Coronary artery fistula; Congenital heart disease; Surgery; Intervention