Congenital coronary artery fistulae: A review of 18 cases with special emphasis on spontaneous closure

Abstract

Between 1972 and 1990, 18 patients (median age 3 years, range 0.1-14 years) with coronary artery fistulae (CAF) were seen at this institution. Of the 16 patients without associated heart defects, two patients presented with congestive heart failure and the remaining 14 were asymptomatic. Fifteen patients had normal origin of two coronary arteries. Two patients had atresia of the proximal right coronary artery and, in one patient, the right coronary artery originated from the left main coronary artery. The QP/QS ranged between 1.0 and 2.8, with a mean of 1.4. Fifteen patients underwent operative closure without any deaths. One patient is being followed medically at present. Two patients showed spontaneous clinical improvement of CAF (complete closure in one and near complete in the other) and remained asymptomatic during a decade of follow-up. Review of the literature suggests operative closure of symptomatic and asymptomatic small CAF during childhood. However, the natural history of minute CAF remains unclear. In addition, symptoms from CAF may spontaneously improve with time.

Coronary artery fistulas: How to manage them

“…Intervention for asymptomatic patients may best be delayed for observation unless the fistula is large. Approximately half of symptomatic neonates are likely to become asymptomatic with the relative size of the fistula decreasing over time [12,13]. Spontaneous closure has been seen in some patients over time, but these cases appear to be in patients with small or medium size fistulas [8].…”

Myocardial Infarction in a 14-Year-Old Girl, Ten Years After Surgical Correction of Congenital Coronary Artery Fistula

“…Congenital coronary artery fistulae in children are rare vascular abnormalities accounting for 0.4% of all congenital heart defects [3,4]. First described by Krause in 1865, over 400 cases have since been reported [8].…”

“…Bacterial endocarditis occurs in about 3% of the cases. Spontaneous closure of CAF has been reported in six children and three adults [4]. Myocardial Pediatric Cardiology infarction is rare [6].…”

Successful Transcatheter Patent Ductus Arteriosus Occluder Embolization of a Congenital Left Coronary Artery Aneurysm and Fistulas Draining into the Right Atrium

“…Spontaneous closure of coronary artery fistula is rare. 4) Early closure is necessary to prevent complications, such as refractory congestive heart failure, myocardial ischemia, or infective endocarditis, which usually develop in the second or third decade of life.…”