Abstract 2262: Predictors of Long-term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae
Background: The optimal management and long-term complications of congenital coronary artery fistulae (CAF) are unknown. Significant morbidities including angina, symptomatic heart failure, and myocardial infarction have been reported following CAF closure; however, predictors that may be associated with adverse outcomes have not been established.
Methods: The records and angiograms of all patients with CAF who underwent a diagnostic cardiac catheterization at Children’s Hospital Boston from 1959 through 2008 were reviewed. Post-surgical patients and those with complex congenital heart disease were excluded. Follow-up information was gathered from medical records and standardized patient phone interviews.
Results: Of 76 subjects identified, 20% had additional congenital heart disease. Forty-four subjects underwent initial transcatheter closure, 20 subjects underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Thirty percent had evidence of a residual fistula following intervention. Three patients whom had initially undergone surgical closure had a second intervention; one repeat surgery and two subsequent transcathether closure. One patient whom had undergone transcathether closure underwent a second transcathether closure for residual fistula. Major complications occurred in 15% of the cohort, including myocardial infarction (7), angina with coronary thrombosis (2), and symptomatic cardiomyopathy (2). The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus (p <0.001). Clinical predictors associated with adverse outcomes included older age (p<0.001), tobacco use (p=0.006), diabetes (p=0.05), systemic hypertension (p<0.001) and hyperlipidemia (p<0.001).
Conclusion: Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction and cardiomyopathy. CAF which drain into the coronary sinus are at particularly high-risk of long-term morbidities after CAF closure, and strategies including long-term anticoagulation should be considered in these patients.