Myocardial Ischemia of Congenital Coronary Artery Fistulae and Delineation of Management / 日本心臓血管外科学会雑誌

ABSTRACT

Long-term follow up (10.0yrs on average) is described of 33 patients with coronary aretry fistulae (CAF) without other cardiac disorders. Of 33 patients, nine cases demonstrated some electrocardiographic ischemic changes (group I), and other twenty-four cases showed no significant electrocardiographic changes (group II) clinically. Symptomatic, hemodynamic and angiographic findings showed no significant difference statistically between both groups. Thirty patients of small to moderate left-to-right shunt ratio (<50∼60%) showed hemodynamic and angiographic stability during the 10.0 years retrograde follow-up period on average. Of 33 patients, seventeen cases have underwent surgical closure of CAF since 1973 to 1990. Seven of the seventeen patients had showed significant myocardial ischemic changes before surgical treatments, and five of the seven cases showed definitive improvement of the electrocardiographic changes seemed to be derived from occlusion of the coronary steal blood flow after surgical operations. There were no operative deaths and no appearance of new myocardial ischemia following the surgical repairs. At present since not only it is unclear whether the CAF predisposes correlate coronary arteries to some premature atherosclerosises but also there are several reports of severe late risks of surgical repair of CAF, surgical indication in the patients of CAF with small-to-moderate left-to-right shunt shou ld be limited to the cases with such as definitive myocardial ischemia or evidence of infective endocarditis.