eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Coronary Artery Fistula: Follow-up

Author: Andrew N Pelech, MD, Professor, Department of Pediatrics, Medical College of Wisconsin; Director of Cardiac Catheterization Laboratory, Cardiology Research Focus and Cardiology Database, Director of Herma Heart Center Clinical Research, Children's Hospital of Wisconsin; Chairman of Wisconsin Pediatric Cardiac Registry
Contributor Information and Disclosures

Updated: May 28, 2009

Follow-up

Further Outpatient Care

  • Provide follow-up care after hospital discharge to check for evidence of ischemia or recurrence of coronary artery fistulae (CAF). Individuals who have undergone coronary surgical interventions and, particularly, patients who have sustained cardiac muscle loss should have ongoing cardiac follow-up monitoring that may include stress studies and repeat angiography as needed.
  • Patients treated surgically and with transcatheter techniques should receive maintenance doses of antiplatelet agents and, perhaps, an anticoagulant regime for the first 6 months postoperatively, until the operative surface has undergone endothelialization. Patients with persisting aneurysmal dilatations may benefit from prolonged antiplatelet agents.
  • Patients remain at risk for development of endocarditis until the flow is stopped and should receive antibiotic prophylaxis for any dental, GI tract, and urologic procedures.

Complications

  • Complications of surgery include myocardial ischemia and/or infarction (reported in 3% of patients) and recurrence of the fistula (4% of patients).
  • Major complications associated with transcatheter embolization relate to manipulation of stabilizing catheters and wires in the coronary vasculature and may include coronary artery spasm, ventricular dysrhythmias, and perforation. Inappropriate positioning or proximal extension of occlusive coils or devices may result in obstruction of side branches and muscle loss. Intimal dissection of the coronary artery or thrombosis also may occur. However, morbidity and mortality rates generally are considered to be low.

Prognosis

  • Recent results of both transcatheter and surgical approaches indicate a good prognosis. Approximately 4% of patients may require additional surgery for recurrence. Life expectancy is considered normal. However, risk of degenerative atherosclerotic disease may be higher if ectasia and dilatation of the coronary artery persist or progress. In young surgical patients, anticipate the involution of the dilated segment of the feeding vessel; this is not the case in adults.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the diagnosis of coronary artery fistula (CAF)
  • Failure to realize that since spontaneous closure occurs in 23% of small fistulae, primarily those arising from the left coronary system, conservative management may be appropriate in some patients
  • Failure to advise patients that they should receive appropriate antibiotics for any dental, oropharyngeal, GI tract, or urologic surgical procedures
 


More on Coronary Artery Fistula

Overview: Coronary Artery Fistula
Differential Diagnoses & Workup: Coronary Artery Fistula
Treatment & Medication: Coronary Artery Fistula
Follow-up: Coronary Artery Fistula
Multimedia: Coronary Artery Fistula
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Padfield GJ. A case of coronary cameral fistula. Eur J Echocardiogr. May 4 2009;[Medline].

  2. Cemri M, Sahinarslan A, Akinci S, Arslan U. Dual coronary artery-pulmonary artery fistulas. Can J Cardiol. Mar 2009;25(3):e95. [Medline].

  3. Schamroth C. Coronary artery fistula. J Am Coll Cardiol. Feb 10 2009;53(6):523. [Medline].

  4. Liberthson RR, Sagar K, Berkoben JP, et al. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation. May 1979;59(5):849-54. [Medline].

  5. Weymann A, Lembcke A, Konertz WF. Right coronary artery to superior vena cava fistula: imaging with cardiac catheterization, 320-detector row computed tomography, magnetic resonance imaging, and transesophageal echocardiography. Eur Heart J. May 20 2009;[Medline].

  6. Chen ML, Lo HS, Su HY, Chao IM. Coronary artery fistula: assessment with multidetector computed tomography and stress myocardial single photon emission computed tomography. Clin Nucl Med. Feb 2009;34(2):96-8. [Medline].

  7. Saglam H, Koçogullari CU, Kaya E, Emmiler M. Congenital coronary artery fistula as a cause of angina pectoris. Turk Kardiyol Dern Ars. Dec 2008;36(8):552-4. [Medline].

  8. Ma ES, Yang ZG, Guo YK, Zhang XC, Sun JY, Wang RR. [Clinical value of 64-slice CT angiography in detecting coronary artery anomalies]. Sichuan Da Xue Xue Bao Yi Xue Ban. Nov 2008;39(6):996-9. [Medline].

  9. [Guideline] Society of Thoracic Surgeons Workforce on Evidence Based Surgery. Antibiotic prophylaxis in cardiac surgery. Part 1, duration of prophylaxis. 2005;[Full Text].

  10. Armsby LR, Keane JF, Sherwood MC, et al. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol. Mar 20 2002;39(6):1026-32. [Medline].

  11. Carrel T, Tkebuchava T, Jenni R, et al. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. Cardiology. Jul-Aug 1996;87(4):325-30. [Medline].

  12. Culham JAG. Abnormalities of the coronary arteries. In: Freedom RM, Mawson JB, Yoo SJ, eds. Congenital Heart Disease: Textbook of Angiocardiography. Armonk, NY: Futura Publishing; 1997:849-67.

  13. De Wolf D, Vercruysse T, Suys B, et al. Major coronary anomalies in childhood. Eur J Pediatr. Dec 2002;161(12):637-42. [Medline].

  14. Demirkilic U, Gunay C, Bolcal C, et al. Are discrete coronary artery fistulae different from coronary arteriovenous malformations?. J Card Surg. Mar-Apr 2005;20(2):124-8. [Medline].

  15. Farooki ZQ, Nowlen T, Hakimi M, Pinsky WW. Congenital coronary artery fistulae: a review of 18 cases with special emphasis on spontaneous closure. Pediatr Cardiol. Oct 1993;14(4):208-13. [Medline].

  16. Freedom RM, Benson LN. The etiology of myocardial ischemia: surgical considerations. In: Pulmonary Atresia with Intact Ventricular Septum. Armonk, NY: Futura Publishing Co; 1989:233.

  17. Gittenberger-de Groot AC, Sauer U, Bindl L, et al. Competition of coronary arteries and ventriculo-coronary arterial communications in pulmonary atresia with intact ventricular septum. Int J Cardiol. Feb 1988;18(2):243-58. [Medline].

  18. Latson LA, Forbes TJ, Cheatham JP. Transcatheter coil embolization of a fistula from the posterior descending coronary artery to the right ventricle in a two-year-old child. Am Heart J. Dec 1992;124(6):1624-6. [Medline].

  19. Mahoney LT, Schieken RM, Lauer RM. Spontaneous closure of a coronary artery fistula in childhood. Pediatr Cardiol. 1982;2(4):311-2. [Medline].

  20. Manghat NE, Morgan-Hughes GJ, Marshall AJ, Roobottom CA. Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults. Heart. Dec 2005;91(12):1515-22. [Medline].

  21. McMahon CJ, Nihill MR, Kovalchin JP, et al. Coronary artery fistula. Management and intermediate-term outcome after transcatheter coil occlusion. Tex Heart Inst J. 2001;28(1):21-5. [Medline]. [Full Text].

  22. Moskowitz WB, Newkumet KM, Albrecht GT, et al. Case of steel versus steal: coil embolization of congenital coronary arteriovenous fistula. Am Heart J. Mar 1991;121(3 Pt 1):909-11. [Medline].

  23. Parga JR, Ikari NM, Bustamante LN, et al. Case report: MRI evaluation of congenital coronary artery fistulae. Br J Radiol. Jun 2004;77(918):508-11. [Medline].

  24. Reidy JF, Tynan MJ, Qureshi S. Embolisation of a complex coronary arteriovenous fistula in a 6 year old child: the need for specialised embolisation techniques. Br Heart J. Apr 1990;63(4):246-8. [Medline].

  25. Said SA, el Gamal MI, van der Werf T. Coronary arteriovenous fistulas: collective review and management of six new cases--changing etiology, presentation, and treatment strategy. Clin Cardiol. Sep 1997;20(9):748-52. [Medline].

  26. Tkebuchava T, Von Segesser LK, Vogt PR, et al. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. J Cardiovasc Surg (Torino). Feb 1996;37(1):29-34. [Medline].

  27. Trehan V, Yusuf J, Mukhopadhyay S, et al. Transcatheter closure of coronary artery fistulas. Indian Heart J. Mar-Apr 2004;56(2):132-9. [Medline].

  28. Urrutia-S CO, Falaschi G, Ott DA, Cooley DA. Surgical management of 56 patients with congenital coronary artery fistulas. Ann Thorac Surg. Mar 1983;35(3):300-7. [Medline].

  29. Vavuranakis M, Bush CA, Boudoulas H. Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn. Jun 1995;35(2):116-20. [Medline].

[ CLOSE WINDOW ]

Keywords

coronary artery fistula, CAF, coronary cameral fistula, coronary arteriovenous fistula, heart disease, coronary fistula, cardiac anomalies, cardiac fistula, cardiac disease, coronary artery anomaly, coronary arterial-venous fistula, CAVF, coronary-pulmonary artery fistula, congestive heart failure, CHF, pulmonary artery branch stenosis, coarctation of the aorta, pulmonary stenosis, coronary stenosis, aortic atresia, myocardial infarction, arrhythmias, infectious endocarditis, aneurysm, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Andrew N Pelech, MD, Professor, Department of Pediatrics, Medical College of Wisconsin; Director of Cardiac Catheterization Laboratory, Cardiology Research Focus and Cardiology Database, Director of Herma Heart Center Clinical Research, Children's Hospital of Wisconsin; Chairman of Wisconsin Pediatric Cardiac Registry
Disclosure: Nothing to disclose.

Medical Editor

Juan Carlos Alejos, MD, Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California at Los Angeles
Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, and International Society for Heart and Lung Transplantation
Disclosure: Actelion Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Julian M Stewart, MD, PhD, Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College
Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.