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Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature

  • Ralf Holzer (a1), Robert Johnson (a1), Giovanna Ciotti (a1), Marco Pozzi (a1) and Denise Kitchiner (a1)...


Coronary artery fistulas are uncommon in children. We conducted a retrospective review of the case notes of 17 children who presented to our institution with the diagnosis of a coronary fistula since 1970. Their median age was 2.3 years. In five patients, there were associated congenital cardiac anomalies, with four having these as part of the spectrum of tetralogy of Fallot. Surgical correction was performed in nine patients, while in five closure was achieved using percutaneous embolization with coils. No complications or deaths were encountered related to the treatments chosen. In two patients, further procedures were needed to close residual fistulas. The median follow-up was 16 years, and on echocardiography, all fistulas appeared to be successfully closed, albeit that we lost three patients to follow up. We also conducted a review of 426 cases of coronary fistulas reported in children in the English literature. We have compared these findings with our institutional experience.


Corresponding author

Correspondence to: Dr Denise Kitchiner, Department of Paediatric Cardiology, Royal Liverpool Children's NHS Trust, Eaton Road, Liverpool L12 2AP, UK. Tel: +44 (0)151 2525 049; Fax: +44 (0)151 2525 643; E-mail:


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Knippel M, Ravizza P, Gullace G, Bana G, Savoia M, Locatelli V, Colombi P. An unusual case of congenital double coronary arteriovenous fistula. Chest 1982; 81: 382384.
Ogden JA. Secondary coronary arterial fistulas. J Pediatr 1971; 78: 7885.
Mahoney LT, Schieken RM, Lauer RM. Spontaneous closure of a coronary artery fistula in childhood. Pediatr Cardiol 1982; 2: 311312.
Urrutia-S CO, Falaschi G, Ott DA, Cooley DA. Surgical management of 56 patients with congenital coronary artery fistulas. Ann Thorac Surg 1983; 35: 300307.
Wilde P, Watt I. Congenital coronary artery fistulas: six new cases with a collective review. Clin Radiol 1980; 31: 301311.
Sherwood MC, Rockenmacher S, Colan SD, Geva T. Prognostic significance of clinically silent coronary artery fistulas. Am J Cardiol 1999; 83: 407411.
Mavroudis C, Backer CL, Rocchini AP, Muster AJ, Gevitz M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg 1997; 63: 12351242.
de Nef JJ, Varghese PJ, Losekoot G. Congenital coronary artery fistula. Analysis of 17 cases. Br Heart J 1971; 33: 857862.
Wong KT, Menahem S. Coronary arterial fistulas in childhood. Cardiology in the Young 2000; 10: 1520.
Dabizzi RP, Teodori G, Barletta GA, Caprioli G, Baldrighi G, Baldrighi V. Associated coronary and cardiac anomalies in the tetralogy of Fallot. An angiographic study. Eur Heart J 1990; 11: 692704.
Brenner JI, Burwell LR, Hubbell MM, Newton Jr MC, Krovetz LJ, Nolan SP. Single coronary artery with a fistula to the main pulmonary artery in a patient with tetralogy of Fallot. Ann Thorac Cardiovasc Surg 1977; 73: 738741.
Lowe JE, Oldham Jr HN, Sabiston Jr DC. Surgical management of congenital coronary artery fistulas. Ann Surg 1981; 194: 373380.
McNamara JJ, Gross RE. Congenital coronary artery fistula. Surgery 1969; 65: 5969.
Satou GM, Perry SB, Gauvreau K, Geva T. Echocardiographic predictors of coronary artery pathology in pulmonary atresia with intact ventricular septum. Am J Cardiol 2000; 85: 13191324.
Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 1979; 59: 849854.
Morgan JR, Forker AD, O'Sullivan Jr MJ, Fosburg RG. Coronary arterial fistulas: seven cases with unusual features. Am J Cardiol 1972; 30: 432436.
Qureshi SA, Tynan M. Catheter closure of coronary artery fistulas. J Interv Cardiol 2001; 14: 299307.
Hakim F, Madani A, Goussous Y, Cao QL, Hijazi ZM. Transcatheter closure of a large coronary arteriovenous fistula using the new Amplatzer Duct Occluder. Cathet Cardiovasc Diagn 1998; 45: 155157.
Okubo M, Nykanen D, Benson LN. Outcomes of transcatheter embolization in the treatment of coronary artery fistulas. Catheter Cardiovasc Interv 2001; 52: 510517.
Pedra CA, Pihkala J, Nykanen DG, Benson LN. Antegrade transcatheter closure of coronary artery fistulas using vascular occlusion devices. Heart 2000; 83: 9496.
Sadiq M, Wilkinson JL, Qureshi SA. Successful occlusion of a coronary arteriovenous fistula using an Amplatzer Duct Occluder. Cardiology in the Young 2001; 11: 8487.
Thomson L, Webster M, Wilson N. Transcatheter closure of a large coronary artery fistula with the Amplatzer Duct Occluder. Catheter Cardiovasc Interv 1999; 48: 188190.
Holzer R, Waller III BR, Kahana M, Hijazi ZM. Percutaneous closure of a giant coronary arteriovenous fistula using multiple devices in a 2-day-old neonate. Catheter Cardiovasc Interv 2003; 60: 291294.



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