Abstract
Clinical Symptoms and age at manifestation of a congenital coronary artery fistula
may vary considerably. They depend on the underlying anatomy and also on the size
of the fistulous connection to the left or right side of the heart. Using colour Doppler
echocardiography for direct visualization of the entire course of the fistulous vessel,
including the site of termination, succeeds only in a small number of cases. Furthermore,
regular coronary vessels branching off proximally and distally of the coronary artery
fistula usually are not recognizable by this method. Only selective angiography provides
this Information and is unchallenged the most important and indispensable diagnostic
technique, especially with regard to surgical treatment. This publication presents
physical, echocardiographic, and angiographic data of 15 patients, who were admitted
to the German Heart Center Munich between 1970 und 1993. By an invasive diagnostic
approach the following arteriovenous fistulous connections were found: from right
coronary artery to right atrium (3 patients) or to right ventricle (3 patients), from
left coronary artery to right atrium or coronary sinus (3 patients), from left coronary
artery to right ventricle (4 patients) and from right and left coronary artery to
right ventricle (2 patients). In 5 patients a “proximal” form of coronary artery fistula
(”side-to-side pattern”) was found, in 8 patients a “distal” form (”end-artery type”),
and in 2 patients a combination of both forms. In 14 patients surgical closure was
performed (6 symptomatic infants, mean age at surgery = 95 days, and 8 asymptomatic
children, mean age at surgery = 7.1 years): 13 patients survived surgery. On an average
of 5 years after surgery all of these 13 patients are in excellent condition (NYHA
functional class I). The experiences in surgical treatment verify the importance of
an exact angiographic visualization of the anatomy of a coronary artery fistula and
the regular coronary vessels branching off proximally and distally of the fistula.
Closure of coronary artery fistulas at the time of diagnosis is recommended also in
asymptomatic patients, since perioperative morbidity and mortality increases in older
patients.
Key words
Coronary artery fistula - Coronary anomaly - Arteriovenous fistula
