Surgical treatment of 52 patients with congenital coronary artery fistulas

Objective To evaluate the outcome of surgical treatment for congenital coronary artery fis tulas (CAF) in 52 patients seen between May 1988 and July 1999.Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7±16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of th ose patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Si xteen patients had associated cardiac lesions. The site of fistula origin was t he right coronary artery in 37 patients (71.2%), and the left coronary artery i n 15 patients (28.8%). The sites of CAF drainage were the right ventricle, rig ht atrium, left ventricle, left atrium and 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 patients with single ostium was 7.34±4.12 mm.Results Cardiopulmonary bypass was used in all patients and no patient died. An arterio tomy was made on the anomalous coronary artery and the proximal opening of a fis tula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were close d. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respec tively. No residual shunt was found before patients were discharged from the ho spital. Forty patients were followed up for a mean period of 3.14±1.84 year s. The remaining 12 patients could not be contacted during follow-up. No clin ical symptoms were found in those patients during follow-up but one patient sti ll presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coro nary fistula.