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Prenatal diagnosis of isolated coronary artery fistulas: progression and outcome in five cases

Published online by Cambridge University Press:  18 September 2015

Gurleen K. Sharland ,
Laura Konta  and
Shakeel A. Qureshi
Gurleen K. Sharland*
Affiliation:
Department of Fetal and Paediatric Cardiology, Evelina London Children’s Hospital, London, United Kingdom
Laura Konta
Affiliation:
Department of Fetal and Paediatric Cardiology, Evelina London Children’s Hospital, London, United Kingdom
Shakeel A. Qureshi
Affiliation:
Department of Fetal and Paediatric Cardiology, Evelina London Children’s Hospital, London, United Kingdom
*
Correspondence to: Dr G. K. Sharland, MD, FRCP, Fetal Cardiology Unit, Evelina London Children’s Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Tel: 0044 2071889201; Fax: 0044 2071882307; E-mail: [email protected]
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Abstract

Objectives

The aim of this study was to describe the clinical characteristics, progression, treatment, and outcomes in isolated coronary artery fistula cases diagnosed prenatally.

Methods

We carried out a retrospective review of babies diagnosed prenatally with coronary artery fistulas between January, 2000 and December, 2013; five fetuses were included. Echocardiographic features and measurements were noted during pregnancy and after birth. Treatment and outcome were noted.

Results

Gestational age at initial diagnosis was between 19 and 22 weeks; four coronary artery fistulas originated from the right and one from the left circumflex coronary artery. Drainage was into the right atrium in four cases and into the left ventricle in one case. There was cardiomegaly in two cases at the initial scan. The size of the fistulas increased during pregnancy in all except one. All prenatal diagnoses were confirmed postnatally. Among all, two patients developed congestive cardiac failure soon after birth and required transcatheter closure of the coronary artery fistula, 5 and 17 days after birth, respectively; three patients remained asymptomatic, and all of them showed progressive dilation of the feeding artery and had closure of the fistula at 20 months, 4 years, and 7 years of age, respectively. During the follow-up period, which ranged 2–14 years, all the patients were alive and well.

Conclusions

Coronary artery fistulas can be diagnosed accurately during fetal life. Some babies may develop congestive cardiac failure soon after birth requiring early treatment. Those treated conservatively should be kept under review as intervention may be required later.

Keywords

Coronary artery fistulacongenital heart defectsfetal echocardiographyfetal heart abnormalities
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 915 - 920
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Copyright
© Cambridge University Press 2015 

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References

1. Effler, DB, Sheldon, WC, Turner, JJ, Groves, LK. Coronary arterio-venous fistulas: diagnosis and surgical management. Report of fifteen cases. Surgery 1967; 61: 41–50.Google Scholar
2. Liberthson, RR, Sagar, K, Berkoben, JP, Weintraub, RM, Levine, FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 1979; 59: 849–854.Google Scholar
3. Valente, AM, Lock, JE, Gauvreau, K, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Intervent 2010; 3: 134–139.Google Scholar
4. Schumacher, G, Roithmaier, A, Lorenz, HP, et al. Congenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects. Thorac Cardiovasc Surg 1997; 45: 287–294.Google Scholar
5. Patel, CR, Lane, JR, Spector, ML, Smith, PC, Waight, DJ. Prenatal diagnosis of ventriculocoronary arterial communication in fetuses with hypoplastic left heart syndrome. J Ultrasound Med 2006; 25: 245–249.Google Scholar
6. Sathanandam, S, Cui, W, Nguyen, NV, et al. Ventriculocoronary artery connections with the hypoplastic left heart: a 4-year prospective study: incidence, echocardiographic and clinical features. Pediatr Cardiol 2010; 31: 1176–1185.Google Scholar
7. Freedom, RM, Anderson, RH, Perrin, D. The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum. Cardiol Young 2005; 15: 447–468.Google Scholar
8. Schleich, JM, Rey, C, Gewillig, M, Bozio, A. Spontaneous closure of congenital coronary artery fistulas. Heart 2001; 85 (Suppl): E6.Google Scholar
9. Malcic, I, Belina, D, Gitter, R, Viljevac, M, Kniewald, H, Krmelk, M. Spontaneous closure of fistula between right coronary artery and right ventricle in an infant. Lijec Vjesn 2009; 131: 65–68.Google Scholar
10. Cotton, JL. Diagnosis of a left coronary artery to right ventricular fistula with progression to spontaneous closure. J Am Soc Echocard 2000; 13: 225–228.Google Scholar
11. Oztunc, F, Gokalp, S, Yuksel, MA, Imamoglu, M, Madazil, R. Prenatal diagnosis of left coronary artery to right ventricle fistula. J Clin Ultrasound 2015; 43: 129–131.Google Scholar
12. Hayashi, T, Inuzuka, R, Ono, H, Katori, T. Prenatal diagnosis of coronary artery fistula: a case report and review of literature. Pediatrics International 2012; 54: 299–302.Google Scholar
13. Mielke, G, Sieverding, L, Borth-Bruns, T, Eichhorn, K, Wallwiener, D, Gembruch, U. Prenatal diagnosis and perinatal management of left coronary artery to right atrium fistula. Ultrasound Obstet Gynecol 2002; 19: 612–615.Google Scholar
14. Hung, JH, Lu, JH, Hung, J, Chen, JD. Prenatal diagnosis of a right coronary-cameral fistula. J Ultrasound Med 2006; 25: 1075–1078.Google Scholar
15. Karagoz, T, Ozkutlu, S, Celiker, A. Percutaneous closure of a prenatally diagnosed large coronary artery fistula with an Amplatzer vascular plug immediately after delivery. Acta Cardiol 2008; 63: 405–408.Google Scholar
16. Khan, MD, Qureshi, SA, Rosenthal, E, Sharland, GK. Neonatal transcatheter occlusion of a large coronary artery fistula with Amplatzer duct occluder. Catheter Cardiovasc Intervent 2003; 60: 282–286.Google Scholar
17. Armsby, LR, Keane, JF, Sherwood, MC, Forbess, JM, Perry, SB, Lock, JE. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol 2002; 39: 1026–1032.Google Scholar
18. Kharouf, R, Cao, QL, Hijazi, ZM. Transcatheter closure of coronary artery fistula complicated by myocardial infarction. J Invasive Cardiol 2007; 19 (Suppl): E146–E149.Google Scholar
19. Latson, LA. Coronary artery fistulas: how to manage them. Catheter Cardiovasc Interv 2007; 70: 110–116.Google Scholar
20. Gowda, ST, Forbes, TJ, Singh, H, et al. Remodeling and thrombosis following closure of coronary artery fistula with review of management: large distal coronary artery fistula–to close or not to close? Catheter Cardiovasc Interv 2013; 82: 132–142.Google Scholar
21. Sharland, GK, Tynan, M, Qureshi, SA. Prenatal detection and progression of right coronary artery to right ventricle fistula. Heart 1996; 76: 79–81.Google Scholar

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