Surgical treatment of 52 patients with congenital coronary artery fistulas

Objective To evaluate the outcome of surgical treatment for congenital coro nary artery fistulas (CAF) in 52 patients seen between May 1988 and July 19 99. Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 1 5.7 +/- 16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical find ings before surgery. Sixteen patients had associated cardiac lesions. The s ite of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drai nage were the right ventricle, right atrium, left ventricle, left atrium an d pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9 .6%) patients, respectively. The mean diameter of the fistula in 43 patient s with single ostium was 7.34 +/- 4.12 mm. Results Cardiopulmonary bypass was used in all patients and no patient died . An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmo nary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found befor e patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14 +/- 1.84 years. The remaining 12 patients coul d not be contacted during follow-up. No clinical symptoms were found in tho se patients during follow-up but one patient still presented with ST-T chan ge. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula.