Kei Koyamada

Congenital Coronary Arteriovenous Fistulas

Abstract One hundred and twelve cases of congenital coronary arteriovenous fistula from the literature and 5 cases of our own were studied. These were classified into seven types according to origin and outlet in an effort to evaluate operative techniques for each type of fistula. Ligation or division of the fistula without the aid of cardiopulmonary bypass is generally the operative procedure of choice, and the results have been excellent (7 deaths among 81 patients operated upon in this collected series). However, serious postoperative complications such as myocardial ischemia, conduction disturbances, and aneurysm formation with sudden rupture were not infrequently reported. It is therefore concluded that operative techniques other than simple ligation or division should be considered for some patients, such as those in Type R 1 or L 1 of our classification, and cardiopulmonary bypass should be employed whenever the fistula is located in the posterior aspect of the heart.