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

Abstract

Acute myocardial infarction developed in a 14-year-old girl, ten years after surgical repair of a coronary artery fistula. Angiography revealed fresh thrombus in the left anterior descending branch of the left coronary artery. The thrombus probably developed in the residual cul-de-sac of the occluded fistula. A procedure to abolish the cul-de-sac was then performed.

Remodeling and thrombosis following closure of coronary artery fistula with review of management

“…The eventual goal of treating CAF is to provide long‐term event‐free survival. Conversely, several case reports and long‐term studies continue to report adverse coronary events such as discrete stenosis, acute and chronic thrombosis causing myocardial infarction and perfusion defects with traditional management . Cheung et al to date has the most extensive follow‐up data; 21 of 41 patients underwent coronary angiograms and all were asymptomatic on follow‐up.…”

“…Many patients are asymptomatic early after CAF closure. More detailed follow‐up studies, however, have identified post CAF closure sequelae including persistent coronary dilatation , residual leak , thrombosis with or without myocardial infarction , coronary stenosis with perfusion defects , and rarely death . The risk factors for early or late coronary events have not been adequately evaluated.…”

Coronary Recanalization Due to Presumed Thrombosis Following Surgical Ligation of a Large Right Coronary Artery to Right Ventricle Fistula

“…Hiraishi et al., 12 reported follow‐up catheterizations including intravascular ultrasound (IVUS) on 3 patients following surgical repair of coronary fistula and reported areas of coronary artery stenosis and irregularities in the vessel wall due to intimal thickening at the site of the regressed coronary artery aneursym. Myocardial infarction due to thrombus formation in dilated proximal CAF channels has been reported months 10 to years 11 after surgical closure of CAF.…”

“…Both approaches have very low reported morbidity and mortality, with the primary long‐term complication being residual flow through the fistula. Rare cases of intracoronary thrombosis and stenosis have been reported 5,10–12 . We report a neonate with congestive heart failure due to a large right coronary artery to right ventricular fistula (CA, CAVF Type B‐Distal, Origin‐RCA, Drainage‐RV, using the nomenclature of Dodge‐Khatami et al 13 …”

Minimally Invasive Sternotomy for Ligation of Congenital Bilateral Coronary Artery to Pulmonary Artery Fistulae: A Case Report

“…In general, open techniques may be associated with a reduced incidence of fistula recurrence compared to their endovascular counterparts. However, they keep the risks associated with median sternotomy, CPB, accidental closure of the main coronary vessels, as well as a small incidence of myocardial infarction 14 …”