Congenital Heart DiseasePrognostic significance of clinically silent coronary artery fistulas
Section snippets
Patients
The computerized databases of the Department of Cardiology, Children’s Hospital in Boston, Massachusetts, and Lahey Hitchcock Clinic in Lebanon, New Hampshire, were searched for all patients with the diagnosis of CAF noted on echocardiogram or at cardiac catheterization from January 1986 to February 1997. The study included patients who (1) had no clinical suspicion of CAF by clinical evaluation, (2) had a small coronary artery fistula found incidentally by color Doppler echocardiography, and
Clinical findings at presentation
Thirty-one patients had an incidental finding of a small coronary artery fistula detected by echocardiography. A total of 73 echocardiograms were performed. The salient demographic, clinical, echocardiographic, and outcome data are summarized in Table I. The mean age at diagnosis was 7.2 ± 8.4 years (range 0.01 to 39.9). The primary indications for echocardiography at presentation were murmur in 23 patients, known congenital heart disease in 2 patients, cardiomegaly in 2 patients, and chest
Discussion
Development and subsequent refinement of color Doppler flow mapping have allowed detailed visualization as well as qualitative and quantitative assessment of blood flow. This technique proved particularly useful in evaluation of abnormalities of the coronary arteries in children.5, 6, 7, 21 Before color Doppler became available, clinically silent CAF were seldom recognized in pediatric patients, because selective coronary angiography was performed in only a few targeted clinical situations. The
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