Abstract

ROBERTOS- VIANA, Suhbert Raúl; RUIZ- GONZALEZ, Sergio; AREVALO- SALAS, Luis Alexis  and  BOLIO- CERDAN, Alejandro. Congenital coronary fistulae, clinical evaluation and surgical management. Bol. Med. Hosp. Infant. Mex. [online]. 2005, vol.62, n.4, pp.242-248. ISSN 1665-1146.

Introduction. The coronary fistulae are a relatively rare pathology with variable incidence which range between 0.2 to 1.2% of all coronary anomalies. Material and methods. We reviewed all the operated cases with diagnosed congenital coronary artery fistulae at Hospital Infantil de Mexico Federico Gomez from January 1975 to May 2004. The analyzed variables were age, sex, weight, clinical presentation, morphology, surgical technique and postoperatory outcome. Results. In the 29 year period reviewed, 7 patients with the diagnosis of coronary artery fistulae have been operated, 3 were females and 4 males.The medium age was 5.1 years and the medium weight 19.6 kg. Five of the anomalies originated from the right coronary artery and 2 from the left coronary. Four drained to the right ventricle and 3 to the right atrium. Four had previous symptoms corresponding 3 with cardiac insufficiency and 1 with infectious endocarditis.The remaining 3 presenting with an intense murmur. The surgical procedures included:2 epicardial ligations (1 video- assisted); 1 section and suture; 1 intravascular suture by coronariotomy and 3 direct closures.All with good postoperative outcome. Conclusions. The surgical closure of the coronary fistulae is indicated in all patients, independently of the symptoms, age, or weight.According to the anatomic characteristics or the presenting complications, the surgical technique must be individualized. Surgical mortality is near zero, with good long term results.

Keywords : Congenital coronary fistulae; surgical management; endocarditis; videoassited cardiac surgery.

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