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Gómez-Arriaga PI, Escribano D, Gómez-Montes E, Villalaín C, Mendoza A, Galindo A. Prenatal diagnosis of isolated coronary artery fistula: systematic review, analysis of perinatal prognostic factors and case report. J Matern Fetal Neonatal Med 2023; 36:2206938. [PMID: 37121905 DOI: 10.1080/14767058.2023.2206938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Isolated coronary artery fistula (CAF) is a rare entity in which evidence for both prognosis and need for perinatal treatment is lacking. We aim to evaluate the characteristics, evolution and perinatal outcomes of reported cases, including one from our center. MATERIAL AND METHODS We performed a systematic review in Medline, Pubmed, and Embase databases for cohort studies or case series related to prenatally diagnosed isolated congenital CAF according to PRISMA guidelines. The search was restricted to articles published until January 2022, including a case report from our center. A descriptive analysis was performed, and perinatal characteristics were dichotomized by outcome (development of symptoms, as well as the need for surgery during the neonatal period). Strength of association between prenatal variables and outcome was evaluated through Odds Ratio. RESULTS Only 27 cases of prenatal diagnosis of isolated CAF have been published, including our patient. Most had their origin in the right coronary artery (63%) and drained in the right ventricle (55.6%). Most cases (72%) developed progressive intrauterine dilation of the fistulous tract, which was usually associated with symptoms of cardiac overload, such as cardiomegaly (57.7%). Up to two-thirds of prenatally diagnosed patients developed heart failure symptoms in the neonatal period, and 84% required postnatal intervention. Prenatal diagnosis of both cardiomegaly and diastolic steal is associated with an OR of 52 and 41 of developing postnatal symptoms. CONCLUSION Prenatal diagnosis of isolated CAF can be achieved with adequate tools and trained sonographers. The development of cardiomegaly and diastolic steal significantly increases the risk of developing postnatal symptoms.
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Affiliation(s)
- Paula I Gómez-Arriaga
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital "12 de Octubre", Complutense University, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - David Escribano
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital "12 de Octubre", Complutense University, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Enery Gómez-Montes
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital "12 de Octubre", Complutense University, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS network) RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Cecilia Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital "12 de Octubre", Complutense University, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS network) RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Mendoza
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Pediatrics, Pediatric Heart Institute, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital "12 de Octubre", Complutense University, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS network) RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
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Mielke G, Sieverding L, Borth-Bruns T, Eichhorn K, Wallwiener D, Gembruch U. Prenatal diagnosis and perinatal management of left coronary artery to right atrium fistula. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:612-615. [PMID: 12047543 DOI: 10.1046/j.1469-0705.2002.00720.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Serious complications due to coronary artery fistulae have been described. Most authors recommend early intervention at the time of diagnosis. We present a case of a fistula originating from a dilated left coronary artery and draining into the right atrium, which was diagnosed prenatally by color Doppler echocardiography. During pregnancy, the echocardiographic findings remained unchanged, and there were no signs of heart failure. After birth, the fistula was confirmed by angiography. Additionally, a persistent left superior vena cava draining into the coronary sinus and a very small ventricular septal defect were detected. The fistula was closed successfully by transcatheter coil embolization. At 17 months old the child was in good clinical condition. Prenatal diagnosis of coronary artery fistulae may be possible and may improve perinatal management and outcome.
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Affiliation(s)
- G Mielke
- Department of Obstetrics and Gynecology, University of Tuebingen, Germany.
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