title: Small coronary artery fistulae in childhood: a 6-year experience of 31 cases in a tertiary paediatric cardiac centre.
abstract: BACKGROUND
  This study describes the incidence and course of children with small coronary artery fistulae over a period of 6 years who presented at a paediatric tertiary-care centre. Materials and methods Age at diagnosis, mode of presentation, location (origin and drainage), and association with a cardiac defect were documented and analysed. All patients obtained an electrocardiogram, and older patients were further evaluated with an exercise treadmill test.
  
  
  RESULTS
  A total of 31 patients were diagnosed with coronary artery fistula via transthoracic echocardiogram and comprised 0.43% of our entire patient group. Mean age was 6.14 years (standard deviation 5.4); 16 patients (52%) had associated cardiac defects. In the remaining 15 patients, the coronary artery fistula was discovered incidentally during diagnostic work-up for heart murmur or chest pain. Among all, 26 patients (84%) had left-sided and five patients (16%) had right-sided coronary artery fistulae. All right coronary artery fistula patients had associated cardiac defects; this was true for 42% of the patients with left coronary artery fistulae. None of the patients required any intervention due to the fistula, and spontaneous closure occurred in 12 patients (39%).
  
  
  CONCLUSIONS
  Small coronary artery fistulae in children are frequently an incidental finding, and many will close spontaneously. Our data are supportive of a conservative, observant approach in asymptomatic patients with small coronary artery fistula in the paediatric population.
authors.affiliation: 1Department of Paediatrics,London Health Sciences Centre,Western University,London,Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Welisch
authors.affiliation: 1Department of Paediatrics,London Health Sciences Centre,Western University,London,Canada.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Norozi
authors.affiliation: 1Department of Paediatrics,London Health Sciences Centre,Western University,London,Canada.
authors.forename: Liz
authors.initials: L
authors.lastname: Burrill
authors.affiliation: 4Department of Paediatrics,Rems-Murr Hospital,Waiblingen,Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Rauch
mesh_terms: D002300:Cardiac Care Facilities; D002648:Child; D000072700:Conservative Treatment; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D016157:Vascular Fistula / Q000453:epidemiology / Q000628:therapy
keywords: Paediatrics; incidence; small coronary artery fistula