Skip to main content
SpringerLink
Log in

Echocardiographic Evaluation of Coronary Artery Fistula in Pediatric Patients

  • Original Articles
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

The management of pediatric patients with coronary artery fistula (CAF) remains controversial because the clinical course of CAF may vary greatly from spontaneous closure to severe complications. The purpose of our study was to report the outcome of CAF in pediatric patients by using echocardiography as an evaluation tool. Between January 1997 and July 2003, 17 patients (age range, 5 months to 14 years; mean, 3.8 years) with coronary angiographically proven CAF were recruited. We divided patients into two groups. Group 1 (n = 4) included patients with symptoms related to CAF (n = 3), persistent coronary artery dilatation for 6 months (n = 4), and/or a continuous waveform of the fistula detected by Doppler (n = 3). Group 2 (n = 13) included patients who were asymptomatic, with normal coronary artery size or coronary artery dilatation less than 6 months, and/or a noncontinuous waveform of the fistula detected by Doppler. Group 1 patients received interventional therapy, whereas group 2 patients were managed conservatively. There were 6 male and 11 female patients. The correlation coefficient of coronary artery diameter measured on echocardiography and angiography was 0.935 and 0.834 in groups 1 and 2, respectively. The diameter of the involved coronary artery was 5.8-9.2 mm (mean, 7.50 ± 1.85) and 1.7-3.8 mm (mean, 2.72 ± 0.59) in group 1 and group 2, respectively. After transcatheter coil embolization, group 1 patients became asymptomatic with no residual fistula and had decrement of the coronary artery diameter (p = 0.035). All group 2 patients remained asymptomatic with no significant change in coronary artery size (p = 0.846) and 3 of them showed spontaneous closure of CAF. Persistent dilatation of the diameter of proximal coronary artery may be a useful parameter for determining subsequent application of interventional therapy. In patients with nonsignificant CAF, conservative follow-up is strongly suggested and intervention procedures may be unnecessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. N Corvaja JW Moses FE Vogel et al. (1999) ArticleTitleExercise-induced ventricular tachycardia associated with coronary arteriovenous fistula and correction by transcatheter coil embolization Cathet Cardiovasc Intervent 46 470–472 Occurrence Handle10.1002/(SICI)1522-726X(199904)46:4<470::AID-CCD20>3.0.CO;2-1 Occurrence Handle1:STN:280:DyaK1M3ivFyiuw%3D%3D

    Article  CAS  Google Scholar 

  2. PR Koenig TR Kimball DC Schwartz (1993) ArticleTitleCoronary artery fistula complicating the evaluation of Kawasaki disease Pediatr Cardiol 14 179–180 Occurrence Handle10.1007/BF00795651 Occurrence Handle1:STN:280:ByuD387msV0%3D Occurrence Handle8415224

    Article  CAS  PubMed  Google Scholar 

  3. RR Liberthson K Sagar JP Berkoben RM Weintraub FH Levine (1979) ArticleTitleCongenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management Circulation 59 849–854 Occurrence Handle1:STN:280:CSaC2cjksVI%3D Occurrence Handle428095

    CAS  PubMed  Google Scholar 

  4. C Mavroudis CL Backer AP Rocchini AJ Muster M Gevitz (1997) ArticleTitleCoronary artery fistulas in infants and children: a surgical review and discussion of coil embolization Ann Thorac Surg 63 1235–1242 Occurrence Handle10.1016/S0003-4975(97)00251-8 Occurrence Handle1:STN:280:ByiB1M7ns1w%3D Occurrence Handle9146308

    Article  CAS  PubMed  Google Scholar 

  5. CJ McMahon MR Nihill JP Kovalchin CE Mullins RG Grifka (2001) ArticleTitleCoronary artery fistula. Management and intermediate-term outcome after transcatheter coil occlusion Tex Heart Inst J 28 21–25 Occurrence Handle1:STN:280:DC%2BD3MvpsVarsw%3D%3D Occurrence Handle11330735

    CAS  PubMed  Google Scholar 

  6. T Misumi K Nishikawa M Yasudo T Suzuki H Kumamaru (2001) ArticleTitleRupture of an aneurysm of a coronary arteriovenous fistula Ann Thorac Surg 71 2026–2027 Occurrence Handle1:STN:280:DC%2BD3Mzms1ajtw%3D%3D Occurrence Handle11426793

    CAS  PubMed  Google Scholar 

  7. M Okubo D Nykanen LN Benson (2001) ArticleTitleOutcomes of transcatheter embolization in the treatment of coronary artery fistulas Cathet Cardiovasc Intervent 52 510–517 Occurrence Handle10.1002/ccd.1114 Occurrence Handle1:STN:280:DC%2BD3MzisVKksA%3D%3D

    Article  CAS  Google Scholar 

  8. SB Perry J Rome JF Keane DS Baim JE Lock (1992) ArticleTitleTranscatheter closure of coronary artery fistulas J Am Coll Cardiol 20 205–209 Occurrence Handle1:STN:280:By2B1MbotlM%3D Occurrence Handle1607526

    CAS  PubMed  Google Scholar 

  9. GS Reeder AJ Tajik HC Smith (1980) ArticleTitleVisualization of coronary artery fistula by two-dimensional echocardiography Mayo Clin Proc 55 185–189 Occurrence Handle1:STN:280:Bi%2BC3Mbht1c%3D Occurrence Handle7354655

    CAS  PubMed  Google Scholar 

  10. JF Reidy RT Anjos SA Qureshi EJ Baker MJ Tynan (1991) ArticleTitleTranscatheter embolization in the treatment of coronary artery fistulas J Am Coll Cardiol 18 187–192 Occurrence Handle1:STN:280:By6B28fjvFw%3D Occurrence Handle2050921

    CAS  PubMed  Google Scholar 

  11. JM Schleich C Rey M Gewillig A Bozio (2001) ArticleTitleSpontaneous closure of congenital coronary artery fistulas Heart 85 E6 Occurrence Handle10.1136/heart.85.4.e6 Occurrence Handle1:STN:280:DC%2BD3M3msFKhtQ%3D%3D Occurrence Handle11250983

    Article  CAS  PubMed  Google Scholar 

  12. G Schumacher A Roithmaier HP Lorenz et al. (1997) ArticleTitleCongenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects Thorac Cardiovasc Surg 45 287–294 Occurrence Handle1:STN:280:DyaK1c7jsl2nug%3D%3D Occurrence Handle9477461

    CAS  PubMed  Google Scholar 

  13. M Shakudo J Yoshikawa K Yoshida Y Yamaura (1989) ArticleTitleNoninvasive diagnosis of coronary artery fistula by Doppler color flow mapping J Am Coll Cardiol 13 1572–1577 Occurrence Handle1:STN:280:BiaB2MnjsFU%3D Occurrence Handle2723269

    CAS  PubMed  Google Scholar 

  14. MC Sherwood S Rockenmacher SD Colan T Geva (1999) ArticleTitlePrognostic significance of clinically silent coronary artery fistulas Am J Cardiol 83 407–411 Occurrence Handle10.1016/S0002-9149(98)00878-9 Occurrence Handle1:STN:280:DyaK1M7ntVCnuw%3D%3D Occurrence Handle10072233

    Article  CAS  PubMed  Google Scholar 

  15. MG St. John Sutton GA Miller IH Kerr TA Traill (1980) ArticleTitleCoronary artery steal via large coronary artery to bronchial artery anastomosis successfully treated by operation Br Heart J 44 460–463 Occurrence Handle1:STN:280:Bi6D3sbhvVc%3D Occurrence Handle7426209

    CAS  PubMed  Google Scholar 

  16. M Vavuranakis CA Bush H Boudoulas (1995) ArticleTitleCoronary artery fistulas in adults: incidence, angiographic characteristics, natural history Cathet Cardiovasc Diagn 35 116–120 Occurrence Handle1:STN:280:ByqA1crgs1E%3D Occurrence Handle7656302

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Chang Gung Children’s Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung County 833, Taiwan

    C.-D. Liang, C.-F. Huang & S.-C. Huang

  2. Department of Radiology, Chang Gung Children’s Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung County 833, Taiwan

    S.-F. Ko

  3. Chang Gung University, Taoyuan, Taiwan

    C.-D. Liang & S.-F. Ko

Authors
  1. C.-D. Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S.-F. Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C.-F. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S.-C. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.-D. Liang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liang, CD., Ko, SF., Huang, CF. et al. Echocardiographic Evaluation of Coronary Artery Fistula in Pediatric Patients. Pediatr Cardiol 26, 745–750 (2005). https://doi.org/10.1007/s00246-004-0889-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-004-0889-9

Keywords

Search

Navigation