CONGENITAL CORONARO-CARDIAC FISTULAS IN C HILDHOOD - RESULTS OF SURGICAL OCCLUSION OR PERCUTANEOUS EMBOLIZATION

Twenty-four children aged 2 months to 8 years (average: 3 years) with congenital coronary artery fistulae were studied. In 20 cases, the fis tula presented with a continuous murmur; in 4 cases, pulmonary flow wa s increased to such an extent that it led to cardiac failure. Echocard iography and coronary angiography showed that the fistula originated f rom the left coronary artery or one of its branches in 13 cases and fr om the right coronary artery in 11 cases. All but one fistula, which d rained into the left atrial appendage, drained into the right heart ch ambers (ventricle : 14 cases; atrium : 9 cases). Spontaneous regressio n after 9 years was observed in 1 case. The other children were treate d : by surgery in 20 cases (1 external ligature and 19 open heart occl usions) with 2 residual shunts (including the case ligated) which had to be reoperated. Three children underwent percutaneous embolisation r esulting in 1 failure and 2 successes. After an average follow-up of 6 .5 years (5 monts to 15.5 years), all patients were alive and doing we ll with normal resting and exercise ECGs, normal Thallium scintigraphy (5 cases) and normal left ventricular function on echocardiography. S elective control coronary angiography (14 cases) showed a reduction in fistula diameter from 10 +/- 3.7 to 4.5 +/- 1.2 mm (p < 0.0001). The authors conclude that all congenital coronary fistulae should be occlu ded, by percutaneous embolisation when the anatomical features are fav ourable. The other cases require surgical occlusion, the long-term res ults of which are very good.