This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Vladimir P. Podzolkov Bagrat G. Alekyan Osman A. Makhachev Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Makhachev, O. A. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Makhachev, O. A. Related Collections Related Article

ICVTS on-line discussion A Coronary artery fistulae: history and surgical experience

Bakoulev Center for Cardiovascular Surgery, Moscow 121552, Russia

Surgical exclusion of a symptomatic circumflex coronary to right atrium fistula

eComment: The authors presented a very interesting case of a rare congenital anomaly of the coronary arteries [1]. Precise diagnostics and effective correction of this anomaly provided good outcome of surgical correction in intermediate follow-up after surgery.

In connection with this case we would like to make some comments concerning congenital coronary artery fistulae (CAF).

The priority in surgical treatment of CAF belongs to Bjork G and Crafoord C [2]. In 1947 they performed successful ligation of CAF in a 15-year-old boy with suspected PDA; the fistula between the left coronary artery and the pulmonary trunk was accidentally found at operation. As for the priority of Fell E.H. et al, 1958 [3], mentioned in the reviewed paper, their merit consists of the fact that in two out of 4 successfully operated patients (cases 12 and 14) the diagnosis of CAF was made preoperatively. The first CAF correction under cardiopulmonary bypass (CPB) was performed by Swan H. et al. in 1959 [4]: the fistula was approached for the suture from the lumen of the involved coronary artery.

From 1961 till February, 2007, at Bakoulev Center for Cardiovascular Surgery, CAF were diagnosed in 72 patients, in 16 cases (22%) , CAF were associated with other congenital heart defects. The most frequent anatomical variants of CAF were: with the right ventricle in 40 cases (56%), with the pulmonary artery – in 14 cases (19%) and with the right atrium in 13 cases (18%). The experience with surgical treatment comprises 49 cases: in 43 patients the fistulae were closed under CPB, in 6 patients without CPB. Hospital mortality was 2% (1 patient with a communication between the RCA and the LV); in the series of the last 39 consecutive operations (performed from January 1988) hospital mortality was 0%. The experience with transluminal embolization of CAF in our Center comprises 23 cases. The first patient was a boy, aged 2 years 4 months, with a communication between the RCA and the RV; on December 16, 1982, Professor Iu.S. Petrosian [5] performed endovascular embolization of CAF with Gianturco coils.

The reviewed paper describes a communication between the circumflex artery and the right atrium. This is an extremely rare variant of CAF: according to our data, it is encountered in 4.2% (3/72) of cases. Our three patients were 7, 9 and 16 years old. In all cases the fistulae were isolated, located in the distal segment of the CxA. Successful embolization was performed in two patients. In one patient the embolization attempt was unsuccessful; she was operated under CPB. The orifice of the fistula in the circumflex artery was sutured from the right atrium; subsequently an aneurysmorrhaphy was performed.

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1. Benlafqih C, Leobon B, Chabbert V, Glock Y. Surgical exclusion of a symptomatic circumflex coronary to right atrium fistula. Interact CardioVasc Thorac Surg 2007; 6:413–415.[Abstract/Free Full Text]
2. Bjork C, Crafoord C. Arteriovenous aneurysm on the pulmonary artery simulating patent ductus arteriosus Botalli. Thorax 1947; 2:65–68.
3. Fell EH, Weinberg M, Gordon AS, Gasul BM, Johnson FR. Surgery for congenital coronary artery arteriovenous fistulae. Arch Surg 1958; 77:331–335.[Medline]
4. Swan H, Wilson JM, Woodwark G, Blount SG Jr. Surgical obliteration of a coronary artery fistula to right ventricle. Arch Surg 1959; 79:820–824.[Medline]
5. Bukharin VA, Podzolkov VP, Petrosian IuS, Dzhafarov DH. Congenital coronary artery fistulae. 5th USA-USSR Joint Symposium on Congenital Heart DiseaseMay 8–10, 1983USA 34–44.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Vladimir P. Podzolkov Bagrat G. Alekyan Osman A. Makhachev Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Makhachev, O. A. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Makhachev, O. A. Related Collections Related Article