日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: Recently, improvements in echocardiography techniques have increased the diagnosis of small asymptomatic coronary arteriovenous fistula (CAVF). However, the natural history and incidence of spontaneous closure are unknown.

Methods: We retrospectively analyzed all patients aged under 18 years with CAVF diagnosed via transthoracic two-dimensional doppler echocardiography between 2009 and 2019.

Results: In total, 65 (34 boys) children were diagnosed with CAVF and were enrolled in the analysis. The median age at diagnosis was 4 (0–86) months, and the mean follow-up period was 42 (0–215) months. Spontaneous closure of CAVF was observed in 31 (48％) children. There was no significant difference in terms of closure rate according to gender. Meanwhile, the left and right coronary arteries remarkably differed in terms of CAVF patency according to origin (p＜0.05). Moreover, there was a significant difference between the pulmonary artery and the ventricle in terms of CAVF patency according to drainage (p＜0.05). One patient underwent coil embolization at the age of 1 year and 4 months. However, no other intervention was required. None of the patients had ischemia or heart failure during the clinical course.

Conclusion: Approximately 48％ of patients experienced spontaneous closure of CAVF. The closure rate was higher than that previously reported, and it differed based on origin and opening of the fistula. Hence, assessment of the origin and opening of the fistula may be useful during follow-up.