A neonatal case of congenital coronary artery fistula.
Coronary artery fistulae (CAF) are rare forms of congenital heart disease with an incidence of one in 50 000 live births. The authors present the case of an asymptomatic neonate with a precordial murmur. Pre and postductal saturations, blood pressure and ECG were normal. Echocardiography revealed a large right coronary artery fistula to the right ventricle (4.5 mm). At 11 months, transcatheter occlusion of the fistula with a vascular plug was performed. A year on, the child was thriving, ECG and echocardiogram remained normal. CAF complications and symptoms (including aneurysm, myocardial ischaemia, angina, heart failure and dyspnoea) are commoner in older patients, so traditionally we intervene early. With increasing case reports of spontaneous closure of even large and symptomatic fistulae, management of especially asymptomatic children is unclear. Long-term complications of intervention also remain largely unknown. As such more information is required on the conditions natural history to better manage patients and counsel parents.
Paediatrics Department, Good Hope Hospital, Birmingham, UK. aqt.ismail@bnc.oxon.org
Abdul Qader Tahir
AQ
Ismail
Anjum
A
Gandhi
Tarak
T
Desai
Oliver
O
Stumper
D001159:Arterio-Arterial Fistula / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D055989:Septal Occluder Device