Congenital arteriovenous coronary fistulae are a rare condition of a direct communication between a coronary artery and one of the cardiac chambers, the coronary sinus, the superior vena cava or the pulmonary artery. In most instances the diagnosis is made during heart catheterization for @entity301 . Whether congenital coronary artery fistulae should be treated by transcatheter intervention or surgery and in which @entity1 @entity292 closure should be performed is controversial. This report summarizes our experience of the surgical treatment of congenital arteriovenous coronary fistulae in 14 @entity1 at the Deutsches Herzzentrum Berlin between March 1988 and April 1997. There were seven females and seven males aged from 3 to 67 years (mean 47 years). We analyzed the symptomatic status (NYHA class) preoperatively and in the late outcome, the preoperative angiographic data and the surgical techniques. The right coronary artery was affected in six, the left in six, and both arteries in two cases. The fistulae drained into the pulmonary artery in eight cases, into the superior vena cava and into the right atrium in two cases, and into the right ventricle and into the coronary sinus once. Fistula closure was unsuccessfully attempted interventionally in two @entity1 and surgically in one @entity1 in another institution. Twelve of the @entity1 exhibited additional @entity299 requiring surgery: seven cases presented additional @entity453 , one @entity339 , one persistent ductus arteriosus, one an @entity439 of the right coronary artery, and two an @entity118 . We performed @entity292 closure either by ligating or transsecting the @entity292 as well as by closure of the @entity292 's drainage opening. Surgery and postoperative courses were uneventful in all @entity1 . Most of the @entity1 (93%) were in good clinical condition (NYHA I-II) after a mean follow-up period of 6.6 years (range 3-11). Fistula closure should be performed in @entity1 who are symptomatic or who have a hemodynamic relevant shunt. In asymptomatic @entity1 and small left-to-right shunt, @entity292 closure should also be performed to prevent later complications. Surgical @entity292 closure should be employed in @entity1 with larger and more complex fistulae, especially if interventional therapy failed, and for @entity1 with additional cardiac conditions that necessitate surgery.

[Congenital coronary fistulas: the most frequent XXXX ].

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity339 :: ('MESH:D008944', 'Disease') :: ['mitral valve disease'] @entity301 :: ('MESH:D003327', 'Disease') :: ['coronary or congenital heart disease'] @entity118 :: ('MESH:D006344', 'Disease') :: ['atrial septal defect'] @entity292 :: ('MESH:D005402', 'Disease') :: ['fistula'] @entity439 :: ('MESH:D000783', 'Disease') :: ['aneurysm'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac disease'] @entity453 :: ('MESH:D003324', 'Disease') :: ['coronary artery disease']
@entity301 :: (MESH:D003327,Disease) :: ['congenital coronary anomaly']
