ABSTRACT
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.
