Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae

Circ Cardiovasc Interv. 2010 Apr;3(2):134-9. doi: 10.1161/CIRCINTERVENTIONS.109.883884. Epub 2010 Mar 23.

Abstract

Background: Significant morbidities, including angina, symptomatic heart failure, and myocardial infarction, have been reported after coronary artery fistula (CAF) closure; however, predictors that may be associated with adverse outcomes have not been established. The goal of this investigation is to describe the long-term outcomes witnessed in patients with either treated or untreated CAF at our institution and to investigate whether certain features predicted adverse outcomes.

Methods and results: The records and angiograms of patients with CAF who underwent a diagnostic cardiac catheterization at Children's Hospital Boston from 1959 through 2008 were reviewed. Of 76 patients identified, 20% were associated with additional congenital heart disease. Forty-four underwent transcatheter closure, 20 underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Three patients who had initially undergone surgical closure had a second intervention, 1 underwent repeat surgery, and 2 underwent transcatheter closure. One patient who had undergone transcatheter closure underwent a second transcatheter closure for residual fistula. Major complications, including myocardial infarction, angina with coronary thrombosis, and symptomatic cardiomyopathy, occurred in 11 (15%) patients. The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus (P<0.001). Clinical predictors associated with adverse outcomes included older age at diagnosis (P<0.001), tobacco use (P=0.006), diabetes (P=0.05), systemic hypertension (P<0.001), and hyperlipidemia (P<0.001).

Conclusions: Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction, and cardiomyopathy. CAF that drain into the coronary sinus are at particularly high-risk of long-term morbidities after closure, and strategies including long-term anticoagulation should be considered.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Arterio-Arterial Fistula / congenital
  • Arterio-Arterial Fistula / diagnosis*
  • Arterio-Arterial Fistula / pathology
  • Arterio-Arterial Fistula / physiopathology
  • Arterio-Arterial Fistula / therapy
  • Child
  • Child, Preschool
  • Coronary Angiography
  • Coronary Thrombosis / etiology*
  • Coronary Vessels / pathology*
  • Coronary Vessels / surgery
  • Drainage
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Postoperative Complications*
  • Smoking
  • Treatment Outcome
  • Young Adult