Early Surgical Repair of the Coronary Artery Fistulae in Children: 30 Years of Experience.

Background: Congenital coronary artery fistula (CAF) is a rare anomaly that may lead to the development of early heart failure or late complications. We reviewed our experience and outcomes of surgically corrected CAF.

Methods: From June 1982 to October 2012, 13 children aged between 3 days and 5.2 years (median 13.9 months) underwent repair of CAF. Four patients (30.8%) presented with congestive heart failure. Both coronary arteries were affected with equal incidence. All patients underwent preoperative cardiac catheterization. Repair was undertaken with cardiopulmonary bypass in 10 patients (76.9%), and 5 patients (38.5%) had concomitant repair of associated cardiac lesions. Seven patients (53.8%) underwent epicardial closure, and in 6 patients (46.2%), transcoronary/endocardial closure was used.

Results: There were no early or late deaths. Transient myocardial ischemia occurred in 2 patients (14.4%). One patient (7.7%) underwent reoperation (aortic valve repair) for a bicuspid aortic valve, 22 years after initial surgery. Follow-up data were complete for 12 patients (92.3%), with a median follow-up of 6 years (range, 1 month to 31 years). All patients were in New York Heart Association class I with no symptoms. There were no long-term cardiovascular sequelae, and no patient required coronary reintervention.

Conclusions: Early surgical repair of CAF in children can be performed safely and carries an excellent long-term prognosis.