Diagnosis and Treatment of Congenital Coronary Artery Fistulas_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Hao , MEI Ju , TANG Min , WU Shubin , YANG Qi.

Department of Cardiothoracic Surgery，Xinhua Hospital，School of Medicine，Shanghai Jiaotong University，Shanghai200092，P. R. China;

Corresponding author：

Keywords：

Congenital heart disease; 　Coronary artery fistula; 　Minimally invasive surgery

DOI：

10.7507/1007-4848.20130171

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize diagnosis and treatment outcomes of coronary arterial fistulas （CAFs） so as to improve surgical results. Methods Clinical data of 23 patients with CAFs who underwent surgical repair in Xinhua Hospital，School of Medicine，Shanghai Jiaotong University from July 2006 to January 2013 were retrospectively analyzed. There were 15 male and 8 female patients with their age of 35.4±8.7 years. CAFs originated from left anterior descendingartery in 7 patients，right coronary artery in 13 patients，dual coronary arteries in 1 patient，left main coronary artery in 1 patient，and obtuse marginal artery in 1 patient. CAFs drained into pulmonary artery in 16 patients，right ventricle in 5patients，and right atrium in 2 patients. Twelve patients received surgical repair under off-pump condition with beating heart，and the other 11 patients underwent surgery under cardiopulmonary bypass （CPB）. Surgical techniques included extracardiacgasket interrupted suture ligation，intracardiac mattress suture ligation，intracardiac gasket interrupted suture for fistula repair，and a combination of intracardiac suture ligation and extracardiac repair. Results There was no in-hospital death or seriouspostoperative complication in this group. For the 11 patients undergoing surgical repair under CPB，average CPB time was 78.6±7.4 minutes，and average aortic cross-clamping time was 39.0±5.9 minutes. Postoperatively，patients’ heart functionrecovered well，their symptoms disappeared，and there was no myocardial ischemia or residual fistula. Twelve patients werefollowed up at the outpatient department and via telephone for 3 months to 6 years after discharge. During follow-up，theirheart function all recovered well，and echocardiogram detected no abnormality. There was no late death，myocardial ischemiaor residual fistula. Conclusion All CAFs patients need early surgical repair once their diagnosis is clear. Appropriate surgical strategies should be chosen according to the characteristics of pathological anatomy and associated intracardiaclesions. Surgical outcomes are satisfactory.

Citation： LIU Hao,MEI Ju,TANG Min,WU Shubin,YANG Qi.. Diagnosis and Treatment of Congenital Coronary Artery Fistulas. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(5): 546-550. doi: 10.7507/1007-4848.20130171 Copy

1.	Mavroudis C， Backer CL， Rocchini AP， et al. Coronary artery fistulas in infants and children：a surgical review and discussion of coil embolization. Ann Thorac Surg， 1997， 63 （5）：1235-1242.
2.	Said SA， el Gamal MI， van der Werf T. Coronary arteriovenousfistulas：collective review and management of six new cases—changingetiology， presentation， and treatment strategy. Clin Cardiol， 1997，20 （9）：748-752.
3.	匡锋，周新民，胡建国，等. 先天性冠状动脉瘘的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （1）：22-25．.
4.	Baffa JM， Chen SL， Guttenberg ME， et al. Coronary artery abnorm-alities and right ventricular histology in hypoplastic left heart syndrome.J Am Coll Cardiol， 1992， 20 （2）：350-358.
5.	Calder AL， Co EE， Sage MD. Coronary arterial abnormalities in pulmonary atresia with intact ventricular septum. Am J Cardiol， 1987， 59 （5）：436-442.
6.	Fernandes ED， Kadivar H， Hallman GL， et al. Congenital malformations of the coronary arteries：the Texas Heart Institute experience. Ann Thorac Surg， 1992， 54 （4）：732-740.
7.	Said SM， Dearani JA， Burkhart HM， et al. Surgical management of congenital coronary arterial anomalies in adults. Cardiol Young， 2010， 20 （Suppl 3）：68-85.
8.	Mavroudis C， Dodge-Khatami A， Stewart RD， et al. An overview of surgery options for congenital coronary artery anomalies. Future Cardiol， 2010， 6 （5）：627-645.
9.	Said SA， Lam J， van der Werf T. Solitary coronary artery fistulas：a congenital anomaly in children and adults. A contemporary review. Congenit Heart Dis， 2006 ， 1 （3）：63-76.
10.	Hong GR， Choi SH， Kang SM， et al. Multiple coronary artery-left ventricular microfistulae in a patient with apical hypertrophic cardiomyopathy：a demonstration by transthoracic color Doppler echocardiography. Yonsei Med J， 2003， 44 （4）：710-714.
11.	Iida R， Yamamoto T， Suzuki T， et al. The usefulness of intraoperative transesophageal echocardiography to identify the site of drainage of coronary artery fistula. Anesth Analg， 2005， 101 （2）：330-331.
12.	Cheng HM， Chiang KH， Chang PY， et al. Coronary artery fistula：A rare congenital disorder detected by multidetector computed tomo-graphy. Tzu Chi Medical J， 2011， 1 （23）：90-92.
13.	Huang HC， Liu CY， Lu TM， et al. Applying preoperative multidetector computed tomography to bilateral coronary artery fistulas. J Chin Med Assoc， 2010， 73 （8）：431-434.
14.	Zhang P， Cai G， Chen J， et al. Echocardiography and 64-multislice computed tomography angiography in diagnosing coronary artery fistula. J Formos Med Assoc， 2010， 109 （12）：907-912.
15.	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 （2）：134-139.
16.	Kabbani Z， Garcia-Nielsen L， Lozano ML， et al. Coil embolization of coronary artery fistulas. A single-centre experience. Cardiovasc Revasc Med， 2008， 9 （1）：14-17.
17.	Mangukia CV. Coronary artery fistula. Ann Thorac Surg， 2012， 93 （6）：2084-2092.
18.	卢子润，陈鑫，徐明，等. 先天性冠状动脉瘘的外科治疗. 中国胸心血管外科临床杂志， 2012， 19 （6）：593-596．.
19.	Hajj-Chahine J， Haddad F， El-Rassi I， et al. Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg， 2009， 35 （6）：1086-1088.
20.	Dimitrakakis G， Otto von Oppell U. Comment：Surgical treatment of coronary arteriovenous fistulas. Interact Cardiovasc Thorac Surg， 2011， 13 （6）：674-675.
21.	Mawatari T， Koshino T， Morishita K， et al. Successful surgical treatment of giant coronary artery aneurysm with fistula. Ann Thorac Surg， 2000， 70 （4）：1394-1397.
22.	Gowda ST， Latson LA， Kutty S， et al. Intermediate to long-term outcome following congenital coronary artery fistulae closure with focus on thrombus formation. Am J Cardiol， 2011， 107 （2）：302-308.
23.	Huang YK， Lei MH， Lu MS， et al. Bilateral coronary-to-pulmonary artery fistulas. Ann Thorac Surg， 2006， 82 （5）：1886-1888.
24.	Said SM， Burkhart HM， Schaff HV， et al. Late outcome of repair of congenital coronary artery fistulas--a Word of caution. J Thorac Cardiovasc Surg， 2013， 145 （2）：455-460.
25.	Cheung DL， Au WK， Cheung HH， et al. Coronary artery fistulas：long-term results of surgical correction. Ann Thorac Surg， 2001， 71 （1）：190-195.

1. 　Mavroudis C， Backer CL， Rocchini AP， et al. Coronary artery fistulas in infants and children：a surgical review and discussion of coil embolization. Ann Thorac Surg， 1997， 63 （5）：1235-1242.
2. 　Said SA， el Gamal MI， van der Werf T. Coronary arteriovenousfistulas：collective review and management of six new cases—changingetiology， presentation， and treatment strategy. Clin Cardiol， 1997，20 （9）：748-752.
3. 　匡锋，周新民，胡建国，等. 先天性冠状动脉瘘的外科治疗. 中国胸心血管外科临床杂志， 2010， 17 （1）：22-25．.
4. 　Baffa JM， Chen SL， Guttenberg ME， et al. Coronary artery abnorm-alities and right ventricular histology in hypoplastic left heart syndrome.J Am Coll Cardiol， 1992， 20 （2）：350-358.
5. 　Calder AL， Co EE， Sage MD. Coronary arterial abnormalities in pulmonary atresia with intact ventricular septum. Am J Cardiol， 1987， 59 （5）：436-442.
6. 　Fernandes ED， Kadivar H， Hallman GL， et al. Congenital malformations of the coronary arteries：the Texas Heart Institute experience. Ann Thorac Surg， 1992， 54 （4）：732-740.
7. 　Said SM， Dearani JA， Burkhart HM， et al. Surgical management of congenital coronary arterial anomalies in adults. Cardiol Young， 2010， 20 （Suppl 3）：68-85.
8. 　Mavroudis C， Dodge-Khatami A， Stewart RD， et al. An overview of surgery options for congenital coronary artery anomalies. Future Cardiol， 2010， 6 （5）：627-645.
9. 　Said SA， Lam J， van der Werf T. Solitary coronary artery fistulas：a congenital anomaly in children and adults. A contemporary review. Congenit Heart Dis， 2006 ， 1 （3）：63-76.
10. 　Hong GR， Choi SH， Kang SM， et al. Multiple coronary artery-left ventricular microfistulae in a patient with apical hypertrophic cardiomyopathy：a demonstration by transthoracic color Doppler echocardiography. Yonsei Med J， 2003， 44 （4）：710-714.
11. 　Iida R， Yamamoto T， Suzuki T， et al. The usefulness of intraoperative transesophageal echocardiography to identify the site of drainage of coronary artery fistula. Anesth Analg， 2005， 101 （2）：330-331.
12. 　Cheng HM， Chiang KH， Chang PY， et al. Coronary artery fistula：A rare congenital disorder detected by multidetector computed tomo-graphy. Tzu Chi Medical J， 2011， 1 （23）：90-92.
13. 　Huang HC， Liu CY， Lu TM， et al. Applying preoperative multidetector computed tomography to bilateral coronary artery fistulas. J Chin Med Assoc， 2010， 73 （8）：431-434.
14. 　Zhang P， Cai G， Chen J， et al. Echocardiography and 64-multislice computed tomography angiography in diagnosing coronary artery fistula. J Formos Med Assoc， 2010， 109 （12）：907-912.
15. 　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 （2）：134-139.
16. 　Kabbani Z， Garcia-Nielsen L， Lozano ML， et al. Coil embolization of coronary artery fistulas. A single-centre experience. Cardiovasc Revasc Med， 2008， 9 （1）：14-17.
17. 　Mangukia CV. Coronary artery fistula. Ann Thorac Surg， 2012， 93 （6）：2084-2092.
18. 　卢子润，陈鑫，徐明，等. 先天性冠状动脉瘘的外科治疗. 中国胸心血管外科临床杂志， 2012， 19 （6）：593-596．.
19. 　Hajj-Chahine J， Haddad F， El-Rassi I， et al. Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg， 2009， 35 （6）：1086-1088.
20. 　Dimitrakakis G， Otto von Oppell U. Comment：Surgical treatment of coronary arteriovenous fistulas. Interact Cardiovasc Thorac Surg， 2011， 13 （6）：674-675.
21. 　Mawatari T， Koshino T， Morishita K， et al. Successful surgical treatment of giant coronary artery aneurysm with fistula. Ann Thorac Surg， 2000， 70 （4）：1394-1397.
22. 　Gowda ST， Latson LA， Kutty S， et al. Intermediate to long-term outcome following congenital coronary artery fistulae closure with focus on thrombus formation. Am J Cardiol， 2011， 107 （2）：302-308.
23. 　Huang YK， Lei MH， Lu MS， et al. Bilateral coronary-to-pulmonary artery fistulas. Ann Thorac Surg， 2006， 82 （5）：1886-1888.
24. 　Said SM， Burkhart HM， Schaff HV， et al. Late outcome of repair of congenital coronary artery fistulas--a Word of caution. J Thorac Cardiovasc Surg， 2013， 145 （2）：455-460.
25. 　Cheung DL， Au WK， Cheung HH， et al. Coronary artery fistulas：long-term results of surgical correction. Ann Thorac Surg， 2001， 71 （1）：190-195.

Previous Article
第九届全国创伤学术会议通知
Next Article
第九届全国创伤学术会议通知

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Treatment of Congenital Coronary Artery Fistulas

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content