Spontaneous closure of congenital coronary artery fistulas

Abstract

Six cases of full spontaneous closure of congenital coronary artery fistulas, and one case of near closure, as seen by colour Doppler echocardiography, are presented. It is worth reconsidering the classical view that nearly all cases of spontaneous closure are eligible for surgical or percutaneous correction to prevent the development of significant and potentially fatal complications. As the natural course of coronary artery fistulas is still poorly defined, asymptomatic patients, especially those under 7 years old with small shunts, should be periodically followed up by echocardiography rather than be subjected to operative closure, even by catheterisation.

Figure 1

Two dimensional and Doppler echocardiography, including colour flow mapping, showing a > 5 mm diameter dilation of the left main coronary artery and left anterior descending coronary artery.

Figure 2

Selective angiography of the right coronary artery showing major dilation of the vessel, especially within its distal segment draining to the apex of the right ventricle.

Figure 3

Two dimensional echocardiography revealing the diameters of the left main coronary artery and left anterior descending coronary artery to be normal. Ao, aorta, PA, pulmonary artery.