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Coronary Fistulas -20 years experience -  

Lee Jeong Ryul (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Xenotransplantation Center, Clinical Research Institute Seoul National University Hospital)
Jung Yo Chun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Choi Chang Hyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Kim Woong Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Kim Yong Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Bae Eun Jung (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Noh Chung Il (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Chest Surgery / v.38, no.9, 2005 , pp. 609-615 More about this Journal
Abstract
Background: Some controversy still exists concerning the operative indications of coronary fistulas. Nevertheless, a short-term and long-term outcomes are excellent with surgical interventions. In this study, we assessed our surgical results on this disease entity during the last 20 years. Anatomic diversity was described as well. Material and Method: From April 1986 to March 2005, 20 patients with coronary fistulas underwent surgical correction in Seoul National University Children's Hospital. Their medical records were reviewed retrospectively. Result: Twelve patients ($60\%$) were asymptomatic prior to surgery. All had electrocardiogram and echocardiogram and all but 3 had coro-nary angiogram preoperatively. Anatomically, none of them had two or more coronary fistulas. The sites of origin were left coronary system in 11 patients and right in 9. The draining sites were right ventricle in 11, right atrium in 3, left ventricle in 3, main pulmonary artery in 2, and superior vena cavae in 1. All of the involved, the coro-nary arteries were dilated or aneurismal. In 1 case, there was atherosclerotic change but no ischemic evidence in preoperative electrocardiogram. Operative techniques included external obliteration (13), internal obliteration (5), and both (2). External obliteration was done by ligation of the fistulous tract only in T patients, by fstula ligation plus plication in 3 and by plication or patch closure via fistulotomy in 3. There was no operative mortality. All of postoperative morbidities including transient sinus arrhythmia (2), complete atrioventricular block (1), decreased left ventricular function (2), ventricular tachycardia (1), pericarditis (1), and seizure (1) improved on discharge. The mean follow-up was 55.1$\pm$50.2 months (4.0 months${\~}$18.0 years) and there were no recurrences of fistula. There was 1 second operation for aortic root aneurysm, which developed after external patch closure of right coronary fistula. Conclusion: We demonstrated here that coronary fistulas can be cured with excellent clinical outcome and low operative risk under precise diagnosis. Understanding the anatomic diversity will help to construct surgical plans.
Keywords
Coronary artery fistula; Fistula;
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1 Effler DB, Sheldon WC, Turner JJ, Groves LK. Coronary arteriovenous fistulas: Diagnosis and surgical management. Report of fifteen cases. Surgery 1967;61:41-50   PUBMED
2 Daniel TM, Graham TP, Sabiston DC Jr. Coronary arteryright ventricular fistula with congestive heart failure, surgical correction in the neonatal period. Surgery 1970;67: 985-94
3 Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH. Congenital coronary arteriovenous fistula: report of 13 patients. Review of literature and delineation of management. Circulation 1979;59:849-54   DOI   ScienceOn
4 Fell EH, Weinberg J, Gordon AS, Gasul BM, Johnson FR. Surgery for congenital coronary artery arteriovenous fistula. Arch Surg 1958;77:331-5   DOI
5 Lowe JE, Sabiston DC Jr. Congential malformations of the coronary circulation. In: Sabiston DC Jr, Spencer FC. Gibbon's surgery of the chest, 4th ed. Philadelphia: WB Saunders. 1983:1409-24
6 Araya I, Oda Y, Yamamoto K, Tanaka S, Nabeshima Y. Surgical experiences with congenital coronary arteriovenous fistula. Jap J Thorac Surg 1966;19:281-4
7 Lukacs L, Arvay A. Bilateral congenital coronary arterypulmonary artery fistulas: report of two cases and review of the literature. J Cardiovasc Surg 1986;27:90-3
8 Francis CK, Sacheti CK, Cohen RB. Fistulous communication between the left coronary artery and main pulmonary artery. A thirteen year follow-up. Cath and Cardiovasc Diag 1979;5:357-66   DOI   ScienceOn
9 Jaffe RB, Glancy DL, Epstein SE, Brown BG, Morrow AG. Coronary arterial-right heart fistulae. Long term Observations in seven patients. Circulation 1973;47:133-43   DOI   ScienceOn
10 Gillebert C, Van Hoof R, Van de Werf F, Piessens J, De Geest H. Coronary artery fistulas in an adult population. Eur Heart J 1986;7:437-43
11 John S, Perianayagam WJ, Muralidharan S, et al. Surgical treatment of congenital coronary artery fistula. Thorax 1981; 36:350-4   DOI   ScienceOn
12 Cheung DLC, Au WK, Cheung HH, Chiu CS, Lee WT. Coronary artery fistulas: Long-term results of surgical correction. Ann Thorac Surg 2001;71:190-5   DOI   ScienceOn
13 Ogden JA, Stansel HC Jr. Coronary arterial fistulas terminating in the coronary venous system. J Thorac Cardiovasc Surg 1972;63:172-82
14 Lowe JE, Oldham HN, Sabiston DC Jr. Surgical management of congenital coronary artery fistulas. Ann Surg 1981;194:373-80   DOI   ScienceOn
15 Tkebuchava T, Vonsegesser LK, Vogt PR, Jenni R, Arbenz U, Turina M. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. J Cardiovasc Surg 1996;37:29-34
16 Cooley DA, Ellis PR Jr. Surgical considerations of coronary arterial fistula. Am J Cardiol 1962;10:467-74   DOI   ScienceOn
17 Gasul BM, Arcillar RA, Fell EH, Lynfield J, Bioff JP, Luan LL. Congenital coronary arteriovenous fistula. Pediatrics 1960;25:531-60
18 Rittenhouse EA, Doty DB, Ehrenhaft JL. Congenital coronary artery-cardiac chamber fistula: review of operative management. Ann Thorac Surg 1975;20:468-85   DOI   ScienceOn
19 Shubrooks SJ, Naggar CZ. Spontaneous near closure of coronary artery fistula. Circulation 1978;57:197-9   DOI   ScienceOn
20 Meyer J, Reul GJ, Mullins CE, McCoy J, Hallman GL, Cooley DA. Congenital fistula of the coronary arteries, clinical considerations and surgical management in 23 patients. J Cardiovasc Surg 1975;16:506-11