Coronary arterial fistulas in childhood

We reviewed 16 patients with coronary arterial fistulas seen between 1976 a nd 1997, and aged 2 days to 16 years, with a median age of 3.2 years. Only four patients were symptomatic: two had heart failure, one had exertional d yspnoea, and one infective endocarditis. The fistulas originated from the r ight coronary artery in seven patients, from the left coronary artery in se ven, from both coronary arteries in one patient, while the origin was not c learly defined in the final patient. Associated cardiac anomalies were disc overed in six patients, with three of the fistulas being diagnosed at the s ame presentation. Cross-sectional echocardiography had revealed a dilated c oronary artery in 7 out of 11 subjects. The ratio of pulmonary to systemic flows ranged between 0.9 to 3.0, with a median of 1.5. Ten patients were re ferred for corrective surgery without any mortality. Trans-catheter closure was successfully undertaken in one patient, while spontaneous closure of t he fistula was noted in two patients. We conclude that coronary arterial fi stulas, although rare and potentially serious, are generally treatable.