title: Diagnosis and management of congenital coronary arteriovenous fistula in the pediatric patients presenting congestive heart failure and myocardial ischemia.
abstract: OBJECTIVE
  Four pediatric patients with congenital coronary arteriovenous fistula (CAVF) were reported to remind pediatric practitioners and cardiologists of its diagnosis and management.
  
  
  METHODS
  Four pediatric patients with congenital CAVF from June 1999 to November 2007 were included in this retrospective study. Study modalities included reviews of patients' profiles of clinical features, chest radiograph, Doppler echocardiography, cardiac catheterization with angiography, myocardial perfusion scan, and computed tomography.
  
  
  RESULTS
  All 4 patients were symptomatic. The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. Echocardiography showed dilatation of the coronary artery in all 4 patients, and traced down its origin in 3 and drainage in 4. The fistulas originated from the right coronary artery in 2 patients and left coronary artery in 2, and were drained into the right ventricle in 2, right atrium in 1, and pulmonary artery in 1. Single left coronary artery was found in 1 patient. The pulmonary-to-systemic blood flow ratios ranged from 1.2 to 2.5. Transcatheter coil occlusion was successfully performed in 4 patients through a coaxial delivery system. The symptoms and signs of congestive heart failure and myocardial ischemia disappeared after the procedure.
  
  
  CONCLUSIONS
  Diagnosis of congenital CAVF could be achieved by appreciation of continuous murmur over area unusual for the ductus, and by scrupulous examination of echocardiography as well as angiography of the coronary artery through which coaxial transcatheter coil occlusion could be performed successfully.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Changhua Christian Hospital, Changhua, Taiwan. ferdielee@yahoo.com
authors.forename: Meng-Luen
authors.initials: ML
authors.lastname: Lee
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy