Coronary artery fistulas in neonates, infants, and children: clinical findings and outcome.

Ten patients were diagnosed with coronary artery fistula (CAF) between 1991 and 1998 in our department. The ages of patients ranged from 3 days to 12 years. Five patients were male and five patients were female. Nine patients had single CAF and 1 patient had dual CAFs. CAFs of 7 patients originated from the left coronary artery, and CAFs of 3 patients originated from the right coronary artery. CAFs of 7 patients terminated at the right ventricle, CAFs of 2 patients terminated at the right atrium, and the CAF of 1 patient terminated at the pulmonary artery. Four patients were diagnosed with CAF in the neonate period. All presented with congestive heart failure. Medical therapy was successful in treating congestive heart failure in 2 of these patients, but the other 2 needed operations. One patient presented with subacute bacterial endocarditis at 12 years of age requiring surgical intervention. One patient had a large left-to-right shunt that was surgically repaired. One patient with dual CAFs underwent coil embolization and the larger CAF achieved complete embolization, but the smaller CAF failed. Follow-up data revealed that 1 patient who received an operation died of sepsis due to recurrent bronchiolitis 6 months later. Nine patients were asymptomatic. Because complications including endocarditis may be encountered in later life, we suggest early closure with coil embolization.