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Small coronary artery fistulae in childhood: a 6-year experience of 31 cases in a tertiary paediatric cardiac centre

Published online by Cambridge University Press:  14 July 2015

Eva Welisch ,
Kambiz Norozi ,
Liz Burrill  and
Ralf Rauch
Eva Welisch*
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada
Kambiz Norozi
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany
Liz Burrill
Affiliation:
Department of Paediatrics, London Health Sciences Centre, Western University, London, Canada
Ralf Rauch
Affiliation:
Department of Paediatrics, Rems-Murr Hospital, Waiblingen, Germany
*
Correspondence to: Dr E. Welisch, MD, 800 Commissioners Road E., London, Ontario, Canada N6A 4G5. Tel: 001-519-685-8010; Fax: 001-519-685-8156; E-mail: Eva.welisch@lhsc.on.ca
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Abstract

Background

This study describes the incidence and course of children with small coronary artery fistulae over a period of 6 years who presented at a paediatric tertiary-care centre.

Materials and methods

Age at diagnosis, mode of presentation, location (origin and drainage), and association with a cardiac defect were documented and analysed. All patients obtained an electrocardiogram, and older patients were further evaluated with an exercise treadmill test.

Results

A total of 31 patients were diagnosed with coronary artery fistula via transthoracic echocardiogram and comprised 0.43% of our entire patient group. Mean age was 6.14 years (standard deviation 5.4); 16 patients (52%) had associated cardiac defects. In the remaining 15 patients, the coronary artery fistula was discovered incidentally during diagnostic work-up for heart murmur or chest pain. Among all, 26 patients (84%) had left-sided and five patients (16%) had right-sided coronary artery fistulae. All right coronary artery fistula patients had associated cardiac defects; this was true for 42% of the patients with left coronary artery fistulae. None of the patients required any intervention due to the fistula, and spontaneous closure occurred in 12 patients (39%).

Conclusion

Small coronary artery fistulae in children are frequently an incidental finding, and many will close spontaneously. Our data are supportive of a conservative, observant approach in asymptomatic patients with small coronary artery fistula in the paediatric population.

Keywords

Paediatricssmall coronary artery fistulaincidence
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 738 - 742
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Copyright
© Cambridge University Press 2015 

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Footnotes

*

Eva Welisch and Kambiz Norozi contributed equally to this manuscript

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