Coronary artery fistula

  • Definition
    • Coronary artery fistula is an abnormal connection between one of the coronary arteries and a heart chamber or another blood vessel. The coronary arteries are blood vessels that bring oxygen-rich blood to the heart.

      Fistula means abnormal connection.

      Coronary artery fistula
  • Alternative Names
    • Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula

  • Causes
    • A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries fails to form properly. This most often takes place when the baby is developing in the womb. The coronary artery abnormally attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel (for example, the pulmonary artery).

      A coronary artery fistula can also develop after birth. It may be caused by:

      • An infection that weakens the wall of the coronary artery and the heart
      • Certain types of heart surgery
      • Injury to the heart from an accident or surgery

      Coronary artery fistula is a rare condition. Infants who are born with it sometimes also have other heart defects. These may include:

  • Symptoms
    • Infants with this condition often do not have any symptoms.

      If symptoms do occur, they can include:

      • Heart murmur
      • Chest discomfort or pain
      • Easy fatigue
      • Failure to thrive
      • Fast or irregular heartbeat (palpitations)
      • Shortness of breath (dyspnea)
  • Exams and Tests
    • In most cases, this condition is not diagnosed until later in life. It is most often diagnosed during tests for other heart diseases. However, the health care provider may hear a heart murmur that will lead to the diagnosis with further testing.

      Tests to determine the size of the fistula include:

      • An x-ray of the heart using dye to see how and where blood is flowing (angiogram)
      • Passing a thin, flexible tube into the heart to evaluate pressure and flow in the heart and surrounding arteries and veins (cardiac catheterization)
      • Ultrasound exam of the heart (echocardiogram)
      • Using magnets to create images of the heart (MRI)
      Coronary angiography
  • Treatment
    • A small fistula that is not causing symptoms very often will not need treatment. Some small fistulas will close on their own. Often, even if they do not close, they will never cause symptoms or need treatment.

      Infants with a larger fistula will need to have surgery to close the abnormal connection. The surgeon closes the site with a patch or stitches.

      Another treatment option plugs up the opening without surgery, using a special wire (coil) that is inserted into the heart with a long, thin tube called a catheter. After the procedure in children, the fistula will most often close.

  • Outlook (Prognosis)
    • Children who have surgery mostly do well, although a small percentage may need to have surgery again. Most people with this condition have a normal lifespan.

  • Possible Complications
    • Complications include:

      • Abnormal heart rhythm (arrhythmia)
      • Heart attack
      • Heart failure
      • Opening (rupture) of the fistula
      • Poor oxygen to the heart

      Complications are more common in older patients.

  • When to Contact a Medical Professional
    • Coronary artery fistula is most often diagnosed during an exam by your provider. Call your provider if your infant has symptoms of this condition.

  • Prevention
    • There is no known way to prevent this condition.

  • References
    • Ashwath R, Snyder CS. Congenital defects of the cardiovascular system. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 84.

      Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: Price G, ed. Paediatric Cardiology. 3rd ed. Philadelphia, PA: Elsevier; 2010:chap 45.

      Marelli AJ. Congenital heart disease in adults. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 69.

      Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.