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Small coronary artery fistulae in childhood: a 6-year experience of 31 cases in a tertiary paediatric cardiac centre

Published online by Cambridge University Press:  14 July 2015

Eva Welisch ,
Kambiz Norozi ,
Liz Burrill  and
Ralf Rauch
Eva Welisch*
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada
Kambiz Norozi
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany
Liz Burrill
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada
Ralf Rauch
Affiliation:
Department of Paediatrics, Rems-Murr Hospital, Waiblingen, Germany
*
Correspondence to: Dr E. Welisch, MD, 800 Commissioners Road E., London, Ontario, Canada N6A 4G5. Tel: 001-519-685-8010; Fax: 001-519-685-8156; E-mail: Eva.welisch@lhsc.on.ca
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Abstract

Background

This study describes the incidence and course of children with small coronary artery fistulae over a period of 6 years who presented at a paediatric tertiary-care centre.

Materials and methods

Age at diagnosis, mode of presentation, location (origin and drainage), and association with a cardiac defect were documented and analysed. All patients obtained an electrocardiogram, and older patients were further evaluated with an exercise treadmill test.

Results

A total of 31 patients were diagnosed with coronary artery fistula via transthoracic echocardiogram and comprised 0.43% of our entire patient group. Mean age was 6.14 years (standard deviation 5.4); 16 patients (52%) had associated cardiac defects. In the remaining 15 patients, the coronary artery fistula was discovered incidentally during diagnostic work-up for heart murmur or chest pain. Among all, 26 patients (84%) had left-sided and five patients (16%) had right-sided coronary artery fistulae. All right coronary artery fistula patients had associated cardiac defects; this was true for 42% of the patients with left coronary artery fistulae. None of the patients required any intervention due to the fistula, and spontaneous closure occurred in 12 patients (39%).

Conclusion

Small coronary artery fistulae in children are frequently an incidental finding, and many will close spontaneously. Our data are supportive of a conservative, observant approach in asymptomatic patients with small coronary artery fistula in the paediatric population.

Keywords

Paediatricssmall coronary artery fistulaincidence
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 738 - 742
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Copyright
© Cambridge University Press 2015 

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Footnotes

*

Eva Welisch and Kambiz Norozi contributed equally to this manuscript

References

1. Farooki, ZQ, Pinsky, WW. Congenital coronary artery fistulae: a review of 18 cases with special emphasis on spontaneous closure. Pediatr Cardiol 1993; 14: 208–213.Google Scholar
2. Liberthson, RR, Sagar, K, Berkoben, JP, Weintraub, RM, Levine, FH. Congenital coronary arteriovenous fistula: report of 13 patients, review of literature and delineation of management. Circulation 1979; 59: 849–854.Google Scholar
3. Wong, K, Menahem, S. Coronary arterial fistulas in childhood. Cardiol Young 2000; 10: 15–20.Google Scholar
4. Burch, GH, Sahn, DJ. Congenital coronary artery anomalies: the pediatric perspective. Coronary Artery Dis 2001; 12: 605–616.Google Scholar
5. Mavroudis, C, Backer, CL, Rocchini, AP, Muster, AJ, Gevitz, M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg 1997; 63: 1235–1242.Google Scholar
6. Schumacher, G, Roithmaier, A, Loren, HP, et al. Congenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects. Thorac Cardiovasc Surg 1997; 45: 287–294.Google Scholar
7. Kamiya, H, Yasuda, T, Nagamine, H. Surgical treatment of congenital coronary artery fistulas: 27 years of experience and a review of the literature. J Card Surg 2002; 17: 173–177.Google Scholar
8. Sherwood, MC, Rockenmacher, S, Colan, SD, Geva, T. Prognostic significance of clinically silent coronary artery fistulas. Am J Cardiol 1999; 83: 407–411.Google Scholar
9. Davis, JT, Allen, HD, Wheller, JJ, et al. Coronary artery fistula in the paediatric age group: a 19 year institutional experience. Ann Thorac Surg 1994; 58: 760–763.Google Scholar
10. Ismail, AQT, Stumper, O. A neonatal case of congenital coronary artery fistula. BMJ Case Reports 2012: 1–4.Google Scholar
11. Kirklin, JW, Barrat-Boyes, BG. Congenital anomalies of coronary arteries: coronary artery fistula. In: Kirklin Barrat-Boyes (eds). Cardiac Surgery, 3rd edn. Churchill, Livingston, Philadelphia, PA, 2003: 1240–1247.Google Scholar
12. Mitropoulos, FA, Triantis, G. Congenital Left Main Coronary Artery to Coronary Sinus Fistula. Heart Surg Forum 2011; 14: E255–E257.Google Scholar
13. Holzer, R, Kitchiner, D. Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature. Cardiol Young 2004; 14: 380–385.Google Scholar
14. Nathani, S, Reddy, C, Suresh, PV, Maheshwari, S. An unusual case of left main coronary artery aneurysm with right ventricle fistula. Ann Pediatr Cardiol 2012; 5: 69–71.Google Scholar
15. Kayalar, N, Schaff, HV. Congenital coronary anomalies and surgical treatment. Congenit Heart Dis 2009; 4: 239–251.Google Scholar
16. Valente, AM, Lock, JE, Gauvreau, K, et al. Predictors of long term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv 2010; 3: 134–139.Google Scholar
17. Qureshi, SA. Coronary arterial fistulas. Orphanet J Dis 2006; 1: 1–6.Google Scholar
18. Qureshi, SA, Reidy, JF. Arterio-venous fistulas and related conditions. In: Anderson RH, Baker EJ, Penny DJ, Redington AN, Rigby ML, Wernovsky G. (eds). Paediatric Cardiology, 3rd edn. Churchill, Livingston, Philadelphia, PA, 2010: 1037–1043.Google Scholar
19. Sapin, P, Frantz, E, Jain, A, Nichols, T, Dehmer, GJ. Coronary artery fistula: an abnormality affecting all age groups. Medicine 2009; 69: 101–113.Google Scholar
20. Latson, LA. Coronary artery fistulas: how to manage them. Core curriculum. Cath Cardiovasc Interv 2007; 70: 110–116.Google Scholar
21. Jaffe, RB, Glancy, L, Epstein, SE, Brown, BG, Morrow, AG. Coronary arterial-right heart fistulae: long term observations in seven patients. Circulation 1973; 47: 133–143.Google Scholar
22. Gowda, RM, Vasava, BC, Khan, IA. Coronary artery fistulas: clinical and therapeutic considerations. Inter J Cardiol 2006; 107: 7–10.Google Scholar
23. Said, S, Lam, J, Van der Werf, T. Solitary coronary artery fistulas: a congenital anomaly in children. A contemporary review. Congenit Heart Dis 2006; 1: 63–67.Google Scholar
24. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar

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