Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management.

Abstract

New patients (13) and 174 other patients with coronary arteriovenous fistula (CAVF) were reviewed to delineate the course and management of CAVF and to clarify the role of surgical ligation in the young asymptomatic patient. Patients were grouped according to age: 99 patients (4 new and 95 others) were < 20 yr old and 88 (9 new and 79 other) were .gtoreq. 20 yr old. Of those under 20 yr of age, 19% had preoperative symptoms or CAVF-related complications, including congestive heart failure (CHF) in 6%, subacute bacterial endocarditis [SBE] in 3% and death in 1 patient. Patients (76) younger than 20 yr old had CAVF ligation with only 1 significant complication, including CHF in 19%, SBE in 4%, myocardial infarction (MI) in 9%, death in 14% and fistula rupture in 1 patient. Of 43 ligated older patients, 23% had surgical complications, including MI in 3 and death in 3. Mean pulmonic-to-systemic flow in the entire group was 1.6:1 and did not differ significantly in those with or without symptoms or complications. One new patient and one other had spontaneous CAVF closure. Early elective ligation of CAVF is indicated in all patients because of the high incidence of late symptoms and complications and increased morbidity and mortality associated with ligation in older patients.