Coronary artery fistula


Definition

Coronary artery fistula is an abnormal connection between one of the coronary arteries and a heart chamber or another blood vessel. The coronary arteries are blood vessels that bring oxygen-rich blood to the heart.

Fistula means abnormal connection.

Alternative Names

Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula

Causes

This EM Should be displayed at the top of the article section "Causes"

A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries fails to form properly. This most often takes place when the baby is developing in the womb. The coronary artery abnormally attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel (for example, the pulmonary artery).

A coronary artery fistula can also develop after birth. It may be caused by:

Coronary artery fistula is a rare condition. Infants who are born with it sometimes also have other heart defects. These may include:

Symptoms

Infants with this condition often do not have any symptoms.

If symptoms do occur, they can include:

Exams and Tests

In most cases, this condition is not diagnosed until later in life. It is most often diagnosed during tests for other heart diseases. However, the health care provider may hear a heart murmur that will lead to the diagnosis with further testing.

Tests to determine the size of the fistula include:

Treatment

A small fistula that is not causing symptoms very often will not need treatment. Some small fistulas will close on their own. Often, even if they do not close, they will never cause symptoms or need treatment.

Infants with a larger fistula will need to have surgery to close the abnormal connection. The surgeon closes the site with a patch or stitches.

Another treatment option plugs up the opening without surgery, using a special wire (coil) that is inserted into the heart with a long, thin tube called a catheter. After the procedure in children, the fistula will most often close.

Outlook (Prognosis)

Children who have surgery mostly do well, although a small percentage may need to have surgery again. Most people with this condition have a normal lifespan.

Possible Complications

Complications include:

Complications are more common in older patients.

When to Contact a Medical Professional

Coronary artery fistula is most often diagnosed during an exam by your provider. Call your provider if your infant has symptoms of this condition.

Prevention

There is no known way to prevent this condition.

References

Ashwath R, Snyder CS. Congenital defects of the cardiovascular system. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 84.

Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: Price G, ed. Paediatric Cardiology. 3rd ed. Philadelphia, PA: Elsevier; 2010:chap 45.

Marelli AJ. Congenital heart disease in adults. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 69.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.

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