Surgical Management of Coronary Artery Fistulas in Children

• Published in: Journal of chest surgery Vol. 57; no. 1; pp. 79 - 86
• Main Authors: Song, Youngkwan, Choi, Eun Seok, Kim, Dong-Hee, Kwon, Bo Sang, Park, Chun Soo, Yun, Tae-Jin
• Format: Journal Article
• Language: English
• Published: The Korean Society for Thoracic and Cardiovascular Surgery 05-01-2024; Korean Society for Thoracic & Cardiovascular Surgery; 대한심장혈관흉부외과학회
• Subjects: child; Clinical Research; coronary artery fistula; surgical management; 흉부외과학
• ISSN: 2765-1606; 2765-1614
• DOI: 10.5090/jcs.23.101

Background: This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. Methods: We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1–25.6 years) Results: The median age and body weight at repair were 3.1 years (range, 0–13.4 years) and 14.4 kg (range, 3.1–42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Conclusion: Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.