Coronary Artery Fistula Follow-up
- Author: Monesha Gupta, MD, MBBS, FAAP, FACC, FASE; Chief Editor: Stuart Berger, MD more...
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.
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.
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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