title: Early Surgical Repair of the Coronary Artery Fistulae in Children: 30 Years of Experience.
abstract: BACKGROUND
  Congenital coronary artery fistula (CAF) is a rare anomaly that may lead to the development of early heart failure or late complications. We reviewed our experience and outcomes of surgically corrected CAF.
  
  
  METHODS
  From June 1982 to October 2012, 13 children aged between 3 days and 5.2 years (median 13.9 months) underwent repair of CAF. Four patients (30.8%) presented with congestive heart failure. Both coronary arteries were affected with equal incidence. All patients underwent preoperative cardiac catheterization. Repair was undertaken with cardiopulmonary bypass in 10 patients (76.9%), and 5 patients (38.5%) had concomitant repair of associated cardiac lesions. Seven patients (53.8%) underwent epicardial closure, and in 6 patients (46.2%), transcoronary/endocardial closure was used.
  
  
  RESULTS
  There were no early or late deaths. Transient myocardial ischemia occurred in 2 patients (14.4%). One patient (7.7%) underwent reoperation (aortic valve repair) for a bicuspid aortic valve, 22 years after initial surgery. Follow-up data were complete for 12 patients (92.3%), with a median follow-up of 6 years (range, 1 month to 31 years). All patients were in New York Heart Association class I with no symptoms. There were no long-term cardiovascular sequelae, and no patient required coronary reintervention.
  
  
  CONCLUSIONS
  Early surgical repair of CAF in children can be performed safely and carries an excellent long-term prognosis.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Deane
authors.initials: D
authors.lastname: Yim
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Yong
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; University of Melbourne and Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; University of Melbourne and Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; University of Melbourne and Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: igor.konstantinov@rch.org.au.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016157:Vascular Fistula / Q000151:congenital* / Q000601:surgery*; D014656:Vascular Surgical Procedures