Original article: cardiovascular
Coronary artery fistulas: long-term results of surgical correction

https://doi.org/10.1016/S0003-4975(00)01862-2Get rights and content

Abstract

Background. Opinions vary as to whether operation should be offered patients with coronary artery fistula, particularly to those who are asymptomatic. Published studies lacked long-term follow-up data.

Methods. We studied 41 patients with coronary artery fistula operated in our unit in the past 30 years with restudies including coronary angiograms in those who agreed to the investigation.

Results. There was no operative mortality and operative morbidity was low. The mean duration of follow-up was 9.1 years and 96.9% of the patients were asymptomatic. Twenty-one patients had a coronary angiogram. The native coronary artery either remained dilated and tortuous, or more frequently had thromboses with a short proximal stump. (None of these patients had evidence of myocardial ischemia.) Four patients had demonstrable recurrence fistula but without hemodynamic disturbance.

Conclusions. We advocate operation for all patients with coronary artery fistulas and demonstrable shunting in view of minimal operative risks. Small asymptomatic fistulas without demonstrable shunting should be left alone. The relatively high incidence of residual or recurrent fistula makes long-term follow-up mandatory.

Section snippets

Patients and methods

Between 1968 and 1997, 41 patients with congenital coronary artery fistulas were admitted to the Department of Surgery, the Grantham Hospital, Hong Kong. All of them had surgical correction. Preoperative workup included roentgenographic, electrocardiographic, echocardiographic, and angiographic studies. The origin and sites of entry of the fistulas were defined and the degree of shunting calculated. Other concomitant cardiac abnormalities were also noted. Operation consisted of obliteration of

Results

Forty-one patients with coronary artery fistula were operated in the past 30 years between 1968 and 1997. The mean age was 23.2 ± 1.6 years (one standard deviation), the youngest was 2.3 years old and the oldest 58. Nineteen were men and 22 were women. Among this group of patients, only 28 were symptomatic (68.3%) of which 14 (77.8%) were more than 20 years old. Twelve of the 14 asymptomatic patients were younger than 20 years. Three patients were asymptomatic when the fistula was first

Comment

Congenital coronary artery fistula was first described by Krause in 1865, but it was not until 1958 that Fell and colleagues [2] described the first successful surgical treatment. Accurate clinical diagnosis was extremely difficult without the help of coronary angiograms and patients were not uncommonly explored with a presumptive diagnosis of a patent ductus arteriosus, a ruptured sinus of Valsalva, a ventricular septal defect with aortic regurgitation, an aortopulmonary window, an

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