title: Clinical presentation of coronary arteriovenous fistula according to age and anatomic orientation.
abstract: BACKGROUND
  Coronary arteriovenous fistulas (CAVFs) are direct connections from one or more coronary arteries to cardiac chambers or a large vessel. They are mostly of congenital origin. The aim of this study was to describe clinical presentation and also delineate the course and management of CAVF.
  
  
  METHODS
  Clinical data, chest x-rays, echocardiographic and angiographic evaluation of 40 patients with congenital CAVF during 1990 to 2008 were reviewed retrospectively.
  
  
  RESULTS
  Seventeen patients were ≤ 20 years old (42.5%) were mostly asymptomatic, and twenty tree cases were older than 20 years old (57.5%), mostly symptomatic (P<0.05). Twenty one (52.5%) patients had pure CAVF and nineteen (47.5%) patients with associated intarcardiac congenital heart disease (15%) or acquired valvular and coronary arteries diseases (32.5%). CAVFs mostly originated from left anterior descending artery (LAD) (42.5%) and mostly drained into the main pulmonary artery (MPA) (35 %). Twenty-four patients underwent CAVF surgical ligation. From twenty-one patients with pure CAVF, eight (38%) patients were complicated by congestive heart failure and aneurism formation of fistula.
  
  
  CONCLUSIONS
  Unlike some previous reports, in our study, the most prevalent origin site for CAVFs was the left anterior descending (LAD). Most patients with CAVFs especially those who went first diagnosed before 20 years old were asymptomatic. On the other hand, as the continuous murmur is not always detected in children or infants, consequently, cases of spontaneous closure may remain undetected. All symptomatic and asymptomatic patients with moderate to severe shunting should be operated on and minimal morbidity and good surgical results could be expected.
authors.affiliation: Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Zamani
authors.affiliation: Pediatric Cardiology Department of Shahid Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Meragi
authors.affiliation: Pediatric Cardiology Department of Shahid Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohamad Yousef
authors.initials: MY
authors.lastname: Arabi Moghadam
authors.affiliation: Mashhad University of Medical Sciences, Mashhad. Iran.
authors.forename: Behzad
authors.initials: B
authors.lastname: Alizadeh
authors.affiliation: Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran.
authors.forename: Kazem
authors.initials: K
authors.lastname: Babazadeh
authors.affiliation: Mazandaran university of medical sciences, Sari, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Mokhtari-Esbuie
keywords: CAVF.; Congenital heart disease; Coronary arteriovenous fistula