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Coronary Artery Fistulas in Pulmonary Atresia and Ventricular Septal Defect

Escorts Heart Institute and Research Center, New Delhi, India

For reprint information contact: Sathiakar P Collison, DNB, Tel: 91 11 2682 5000 Fax: 91 11 2682 5013 Email: spcollison{at}gmail.com, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110 025, India.

Pulmonary atresia with ventricular septal defect is an anomaly with highly variable anatomy. Rarely, a coronary artery-to-pulmonary artery fistula may contribute to pulmonary blood flow. Since 1996, we have treated 4 patients with coronary-pulmonary fistula associated with pulmonary atresia and ventricular septal defect. Two fistulas originated from the left coronary, one from the right coronary, and one from a right-sided solitary coronary system. All terminated in the main pulmonary artery, which was adequate in all cases. The fistulas were managed by direct internal closure. Total intracardiac repair was then accomplished in all patients at the same sitting. There was one death. In children with favorable anatomy, direct closure of the fistula from the pulmonary artery is adequate and allows single-stage intracardiac repair.