Coronary-pulmonary artery fistulas in children: A single-center experience

INTRODUCTION: This study aims to evaluate the characteristics and outcomes of children with coronary to pulmonary artery fistulas.
METHODS: The age, gender, duration of follow-up, indications for initial echocardiography, electrocardiography and echocardiography findings, catheter angiography indications, and the outcome of patients were evaluated. Echocardiographic data included additional cardiac anomalies, origin and drainage of the fistulas, presence of coronary artery dilatation, and changes in fistula flow.
RESULTS: The study involved 64 (66.7%) male and 32 (33.3%) female children. Additional cardiac anomalies were present in 34 (35.4%) cases. The origin of the fistula was defined in only 9 cases (by echocardiography and angiography) and the site of origin was: the left anterior descending (55%), the left circumflex (2.5%), and the right coronary (2.5%) artery. Two cases had very mild dilatation of coronary arteries. The drainage of the fistulas was to the anterior aspect of the pulmonary artery (78.7%), the aortic side of the pulmonary artery (4.3%), and the right pulmonary artery (17%). In only 2 cases, catheter angiography was performed with an indication (suspected coronary artery anomaly) related to coronary-pulmonary fistula, and one of them had right coronary artery dilatation. Rate of spontaneous closure was 9.4%. Surgical or percutaneous closure was not considered in any of the cases and none of the cases had any adverse events or symptoms related to the fistula.
DISCUSSION AND CONCLUSION: Coronary to pulmonary artery fistulas seldomly require further investigation. Clinical follow-up with echocardiography and ensuring bacterial endocarditis prophylaxis is usually adequate unless the fistulas are hemodynamically significant and/or symptomatic.