Late outcome of repair of congenital coronary artery fistulas - A word of caution

Sameh M. Said, Harold M. Burkhart, Hartzell V Schaff, Heidi M. Connolly, Sabrina D. Phillips, Rakesh M. Suri, Benjamin W. Eidem, Charanjit S. Rihal, Joseph A. Dearani

Research output: Contribution to journalArticle

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Abstract

Objectives: We reviewed our experience with repair of congenital coronary artery fistulas. Methods: From June 1983 to December 2009, 46 patients (median age, 59 years; range, 1-84 years) underwent surgical repair. The presenting symptoms included angina in 16 patients (35%), congestive heart failure in 11 (24%), and bacterial endocarditis in 5 (11%). Preoperatively, 9 patients (20%) had at least moderate tricuspid regurgitation. Coronary artery dominance was right in 38 patients (83%). Coronary artery aneurysms were found in 8 patients (17%). The most common pattern was right coronary artery-to-coronary sinus fistula (18 patients, 39%); 11 patients had (23%) more than 1 fistula. One patient had undergone previous coil embolization. Results: Cardiopulmonary bypass was used in 39 patients (85%), with extracardiac and intracardiac repair performed in 30 (65%) and 16 (35%), respectively. The most common associated procedures were coronary artery bypass in 13 patients (28%). Early mortality occurred in 1 patient (2%). Postoperative myocardial infarction occurred in 5 patients (11%); 4 of these patients underwent simple ligation or division of their fistulas. The mean follow-up was 6 ± 5.8 years (maximum, 22 years). Late mortality occurred in 11 patients (24%). Two patients underwent reoperation for severe tricuspid regurgitation. Survival was significantly reduced compared with the age- and gender-matched population (P = .03). Residual fistulas were detected in 3 patients (6%), with no reintervention needed. Conclusions: Perioperative myocardial infarction is an important complication of ligation of coronary artery fistulas and can contribute to reduced late survival. The tricuspid valve should be evaluated carefully at repair because of the relatively high rate of residual regurgitation in survivors.

Original languageEnglish (US)
Pages (from-to)455-460
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Fistula
Coronary Vessels
Tricuspid Valve Insufficiency
Ligation
Myocardial Infarction
Coronary Aneurysm
Bacterial Endocarditis
Tricuspid Valve
Survival
Coronary Sinus
Mortality
Cardiopulmonary Bypass
Reoperation
Coronary Artery Bypass
Survivors
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Said, S. M., Burkhart, H. M., Schaff, H. V., Connolly, H. M., Phillips, S. D., Suri, R. M., ... Dearani, J. A. (2013). Late outcome of repair of congenital coronary artery fistulas - A word of caution. Journal of Thoracic and Cardiovascular Surgery, 145(2), 455-460. https://doi.org/10.1016/j.jtcvs.2012.11.028

Late outcome of repair of congenital coronary artery fistulas - A word of caution. / Said, Sameh M.; Burkhart, Harold M.; Schaff, Hartzell V; Connolly, Heidi M.; Phillips, Sabrina D.; Suri, Rakesh M.; Eidem, Benjamin W.; Rihal, Charanjit S.; Dearani, Joseph A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 2, 02.2013, p. 455-460.

Research output: Contribution to journalArticle

Said, Sameh M. ; Burkhart, Harold M. ; Schaff, Hartzell V ; Connolly, Heidi M. ; Phillips, Sabrina D. ; Suri, Rakesh M. ; Eidem, Benjamin W. ; Rihal, Charanjit S. ; Dearani, Joseph A. / Late outcome of repair of congenital coronary artery fistulas - A word of caution. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 2. pp. 455-460.
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abstract = "Objectives: We reviewed our experience with repair of congenital coronary artery fistulas. Methods: From June 1983 to December 2009, 46 patients (median age, 59 years; range, 1-84 years) underwent surgical repair. The presenting symptoms included angina in 16 patients (35{\%}), congestive heart failure in 11 (24{\%}), and bacterial endocarditis in 5 (11{\%}). Preoperatively, 9 patients (20{\%}) had at least moderate tricuspid regurgitation. Coronary artery dominance was right in 38 patients (83{\%}). Coronary artery aneurysms were found in 8 patients (17{\%}). The most common pattern was right coronary artery-to-coronary sinus fistula (18 patients, 39{\%}); 11 patients had (23{\%}) more than 1 fistula. One patient had undergone previous coil embolization. Results: Cardiopulmonary bypass was used in 39 patients (85{\%}), with extracardiac and intracardiac repair performed in 30 (65{\%}) and 16 (35{\%}), respectively. The most common associated procedures were coronary artery bypass in 13 patients (28{\%}). Early mortality occurred in 1 patient (2{\%}). Postoperative myocardial infarction occurred in 5 patients (11{\%}); 4 of these patients underwent simple ligation or division of their fistulas. The mean follow-up was 6 ± 5.8 years (maximum, 22 years). Late mortality occurred in 11 patients (24{\%}). Two patients underwent reoperation for severe tricuspid regurgitation. Survival was significantly reduced compared with the age- and gender-matched population (P = .03). Residual fistulas were detected in 3 patients (6{\%}), with no reintervention needed. Conclusions: Perioperative myocardial infarction is an important complication of ligation of coronary artery fistulas and can contribute to reduced late survival. The tricuspid valve should be evaluated carefully at repair because of the relatively high rate of residual regurgitation in survivors.",
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AU - Suri, Rakesh M.

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AU - Rihal, Charanjit S.

AU - Dearani, Joseph A.

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N2 - Objectives: We reviewed our experience with repair of congenital coronary artery fistulas. Methods: From June 1983 to December 2009, 46 patients (median age, 59 years; range, 1-84 years) underwent surgical repair. The presenting symptoms included angina in 16 patients (35%), congestive heart failure in 11 (24%), and bacterial endocarditis in 5 (11%). Preoperatively, 9 patients (20%) had at least moderate tricuspid regurgitation. Coronary artery dominance was right in 38 patients (83%). Coronary artery aneurysms were found in 8 patients (17%). The most common pattern was right coronary artery-to-coronary sinus fistula (18 patients, 39%); 11 patients had (23%) more than 1 fistula. One patient had undergone previous coil embolization. Results: Cardiopulmonary bypass was used in 39 patients (85%), with extracardiac and intracardiac repair performed in 30 (65%) and 16 (35%), respectively. The most common associated procedures were coronary artery bypass in 13 patients (28%). Early mortality occurred in 1 patient (2%). Postoperative myocardial infarction occurred in 5 patients (11%); 4 of these patients underwent simple ligation or division of their fistulas. The mean follow-up was 6 ± 5.8 years (maximum, 22 years). Late mortality occurred in 11 patients (24%). Two patients underwent reoperation for severe tricuspid regurgitation. Survival was significantly reduced compared with the age- and gender-matched population (P = .03). Residual fistulas were detected in 3 patients (6%), with no reintervention needed. Conclusions: Perioperative myocardial infarction is an important complication of ligation of coronary artery fistulas and can contribute to reduced late survival. The tricuspid valve should be evaluated carefully at repair because of the relatively high rate of residual regurgitation in survivors.

AB - Objectives: We reviewed our experience with repair of congenital coronary artery fistulas. Methods: From June 1983 to December 2009, 46 patients (median age, 59 years; range, 1-84 years) underwent surgical repair. The presenting symptoms included angina in 16 patients (35%), congestive heart failure in 11 (24%), and bacterial endocarditis in 5 (11%). Preoperatively, 9 patients (20%) had at least moderate tricuspid regurgitation. Coronary artery dominance was right in 38 patients (83%). Coronary artery aneurysms were found in 8 patients (17%). The most common pattern was right coronary artery-to-coronary sinus fistula (18 patients, 39%); 11 patients had (23%) more than 1 fistula. One patient had undergone previous coil embolization. Results: Cardiopulmonary bypass was used in 39 patients (85%), with extracardiac and intracardiac repair performed in 30 (65%) and 16 (35%), respectively. The most common associated procedures were coronary artery bypass in 13 patients (28%). Early mortality occurred in 1 patient (2%). Postoperative myocardial infarction occurred in 5 patients (11%); 4 of these patients underwent simple ligation or division of their fistulas. The mean follow-up was 6 ± 5.8 years (maximum, 22 years). Late mortality occurred in 11 patients (24%). Two patients underwent reoperation for severe tricuspid regurgitation. Survival was significantly reduced compared with the age- and gender-matched population (P = .03). Residual fistulas were detected in 3 patients (6%), with no reintervention needed. Conclusions: Perioperative myocardial infarction is an important complication of ligation of coronary artery fistulas and can contribute to reduced late survival. The tricuspid valve should be evaluated carefully at repair because of the relatively high rate of residual regurgitation in survivors.

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