Acquired coronary artery fistula after open heart surgery for congenital heart disease.
BACKGROUND
Most coronary artery fistulas were reported as congenital. Acquired coronary artery fistula occurring after cardiac surgery has rarely been reported.


METHODS
From 1998 to 2003, 10 patients with coronary artery fistula detected by echocardiography after open heart surgery for congenital heart disease were included. Their ages ranged from 2 months to 41 years (median 4.2 years). The underlying heart disease was tetralogy of Fallot in five patients, ventricular septal defect in three, double chamber right ventricle in one, and transposition of the great arteries with ventricular septal defect in the remaining one.


RESULTS
Of these 10 patients, the coronary artery fistula originated from the left coronary artery in four, right coronary artery in two, and unknown origin in the remaining four. The coronary artery fistula drained into the right ventricle in nine and into the left ventricle in the remaining one. The incidence of acquired coronary artery fistula after open heart surgery for congenital heart disease was 0.44% (8/1832). The identified risk factors for acquired coronary artery fistula were reoperation and right ventricular muscle resection in ventricular septal defect. After follow-up for 0.5-12 years (mean 4.1+/-3.3 years), the coronary artery fistula persisted, but neither symptoms nor significant left-to-right shunt was noted.


CONCLUSIONS
Acquired coronary artery fistula is a rare complication after cardiac surgery. Reoperation and resection of right ventricular hypertrophic muscle increase the risk of this complication. Although shunt flow did not increase during follow-up, the significance of acquired coronary artery fistula needs further investigation.
Chiu
Shuenn-Nan
SN
Department of Pediatrics, National Taiwan University Hospital, School of Medicine, National Taiwan University, 7 Chung-Shan S. Rd, Taipei 100, Taiwan.
Wu
Mei-Hwan
MH
Lin
Ming-Tai
MT
Wu
En-Ting
ET
Wang
Jou-Kou
JK
Lue
Hung-chi
HC
D000293:Adolescent; D000328:Adult; D001159:Arterio-Arterial Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D004310:Double Outlet Right Ventricle / Q000601:surgery; D004452:Echocardiography; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery; D016896:Treatment Outcome