title: Remodeling and thrombosis following closure of coronary artery fistula with review of management: large distal coronary artery fistula--to close or not to close?
abstract: BACKGROUND
  To evaluate postdiscovery outcome of coronary artery fistulae (CAF). CAF treatment sequelae and risk factors for coronary thrombosis have not been adequately evaluated.
  
  
  METHODS
  Outcome on follow-up of 16 patients with CAF was reviewed. Risk factors for adverse coronary events were assessed based on type, size, and treatment of CAF.
  
  
  RESULTS
  Median age was 10 years (0.01-56). Seven patients had large, four medium, and five small sizes CAF. Eight had proximal and 8 distal type CAF. There were 7 in the intervention group (IG) and 9 in nonintervention (NIG). In the IG, 1 had myocardial infarction (MI) <24 hr with distal thrombosis following large distal type CAF closure. Follow-up angiograms in 6 pts showed; decrease in conduit coronary artery size towards normal in 4, 1 had discrete intimal stenosis, persistent coronary dilatation in 1, thrombosis of residual proximal fistula segment without MI in 2, evidence of revascularization in 2 and neovascularization in 1 patient. In the NIG, 6 of the 9 pts available for follow-up were asymptomatic. Angiogram available in 1 patient showed persistent coronary dilatation with partial closure.
  
  
  CONCLUSIONS
  Post-CAF treatment sequelae include thrombosis and MI, revascularization, persistent coronary dilatation, remodeling, and decrease in conduit coronary artery size towards normal. The large size distal type of CAF may be at highest risk for coronary thrombosis post closure. The optimal treatment approach to various morphologies of CAF at various ages remains to be determined.
authors: Pediatric cardiology, The Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan 48201-2119, USA. sgowda@dmc.org
authors: Srinath T
authors: ST
authors: Gowda
authors: Thomas J
authors: TJ
authors: Forbes
authors: Harinder
authors: H
authors: Singh
authors: Julie A
authors: JA
authors: Kovach
authors: Lourdes
authors: L
authors: Prieto
authors: Larry A
authors: LA
authors: Latson
authors: Daniel
authors: D
authors: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult