Coronary Artery Fistula Follow-up

  • Author: Monesha Gupta, MD, MBBS, FAAP, FACC, FASE; Chief Editor: Stuart Berger, MD   more...
 
Updated: Jan 12, 2010
 

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 if associated with a cyanotic heart disease.
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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.
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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.
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Contributor Information and Disclosures
Author

Monesha Gupta, MD, MBBS, FAAP, FACC, FASE  Associate Professor of Pediatrics, Division of Pediatric Cardiology and Nephrology, Children's Memorial Hermann Hospital, University of Texas Medical School

Monesha Gupta, MD, MBBS, FAAP, FACC, FASE is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Society of Echocardiography, Medical Council of India, Society for Pediatric Research, and Society of Pediatric Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Juan Carlos Alejos, MD  Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

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

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

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

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

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Selective left coronary artery (LCA) injection demonstrating a markedly enlarged left main (*) with normal size circumflex (CX) and left anterior descending (LAD) branches. The fistula continues across the right ventricle free wall to the atrioventricular groove where it terminates at the crux of the heart in the right atrium (straight arrow). (Reproduced from Congenital Heart Disease, Textbook of Angiocardiography.)
Retrograde aortic root injection, dilated left main (LCA) and circumflex (CX) vessels with the fistulous connection to the right ventricle (arrow). (Reproduced from Congenital Heart Disease, Textbook of Angiocardiography.)
Three-dimensional multidetector row computed tomographic image showing a circumflex artery fistula. The left main stem is greatly dilated (arrow) and a dilated, tortuous circumflex artery becomes aneurysmal (An) before draining into the coronary sinus. Note also the left anterior descending (LAD) branches arising from this dilated vessel (arrowhead). (Image courtesy of 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.)
Selective left coronary angiogram immediately after transcatheter coil occlusion of the circumflex coronary fistula (4 7-mm X 70-mm target coils). A tiny residual leak and the proximal circumflex coronary dilatation are shown. Image courtesy of Texas Heart Institute. (Reproduced from 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.)
 
 
 
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