Management of a large coronary artery fistula in a neonate

• Type of Material: Article
• Authors: MA McKiernan, Emory University; Saleem Almasarweh, Emory University; Paul Chai, Emory University; Holly Bauser-Heaton, Emory University; Joshua Rosenblum, Emory University
• Language: English
• Date: 2023-02-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s)
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.xjtc.2022.11.002
• Title of Journal or Parent Work: JTCVS Techniques
• Volume: 17
• Start Page: 155
• End Page: 158
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Coronary artery fistulas (CAFs) are exceedingly rare.1 They are defined as an abnormal communication between a coronary artery and another cardiac structure or major thoracic vessel. While largely presumed to be asymptomatic, a recent study showed that a majority of neonates/infants presented with heart failure–type symptoms, albeit many of them had a larger fistula size.2 Indications for intervention on CAFs have been controversial because many patients are asymptomatic; however, delaying intervention is associated with a significantly greater risk of death preoperatively and an increased risk of morbidity and mortality postoperatively.3 Therefore, the majority of CAFs are addressed when they are identified. Transcatheter and surgical approaches have been both been used with good success rates; however, the number of neonates undergoing repair by either method remains low.2,4 Here, we present a case of surgical repair of a large CAF in a neonate after an attempted transcatheter closure resulted in iatrogenic tricuspid regurgitation (TR). The institutional review board of Children's Healthcare of Atlanta approved the study protocol and publication of data (approval number: STUDY00001462, date approved: July 18, 2022). Patient written consent for the publication of the study data was waived by the institutional review board, as it was determined to be research not involving human subjects.