Rahmi ÖZDEMİR, Önder DOKSÖZ, Mustafa KARAÇELİK, Berhan GENÇ, Osman Nejat SARIOSMANOĞLU, Barış GÜVEN, Timur MEŞE, Vedide TAVLI, Mehmet KÜÇÜK

Congenital coronary arteriovenous fistulas: An evaluation of 10 pediatric patients

Amaç: Bu çalışmada doğuştan koroner arteriyovenözfistüllerin (KAVF) özellikleri değerlendirildi ve tedavizamanı tartışıldı.Çalışmaplanı: Ocak 2008 - Aralık 2012 tarihleri arasındahastanemizde 10 pediyatrik hastaya KAVF tanısı konuldu.Demografik özellikler, semptomlar, klinik bulgular,elektrokardiyografi, ekokardiyografi, anjiyografi bulguları vetedavi sonrası klinik seyir geriye dönük olarak değerlendirildi.Bul gu lar: Doğuştan koroner arteriyovenöz fistüller altıhastada sol koroner arterden, üç hastada sağ koroner arterdenve bir hastada sol sirkümfleks arterden köken alıyordu. ÇoğuKAVFlerin drenaj yeri beklenildiği gibi sağ ventriküleolurken, sırasıyla 2 ve 1 olmak üzere pulmoner arter ve sağatriyum sık olan diğer drenaj yerleriydi. Şant miktarınınderecesi ve koroner arter genişlemesinin sürekliliğiaçısından hastalar altı ay süreyle takip edildi. Cerrahiveya transkateter kapatmaya dayalı uygun girişim hastayagöre seçildi. Üç hastada fistüllerin anatomik özelliklerininkateter dayalı kapama için uygun olmamasından dolayı,tedavi seçeneği olarak cerrahi ligasyon tercih edildi. Kateterdayalı girişimsel kapama bir hastada başarılı olmadı vecerrahi ligasyon yapıldı.Sonuç: Çalışma bulgularımız, özellikle ileri yaşta kalpyetmezliği, miyokard iskemisi, infektif endokardit ve aritmigibi komplikasyon riskinin yüksek olması nedeniyle, KAVFninçocukluk çağında teşhis edilmesinin önemli olduğunugöstermektedir.

Doğuştan koroner arteriyovenöz fistüller: 10 pediyatrik hastanın değe rlendirilmesi

Background: This study aims to assess the characteristics of congenital coronary arteriovenous fistulas (CAVFs) and discuss the timing of treatment. Methods: Between January 2008 and December 2012, 10 pediatric patients with CAVF were diagnosed in our institution. Demographic characteristics, symptoms and clinical findings electrocardiographic, echocardiographic, angiographic findings clinical courses after treatment were evaluated retrospectively. Results: Congenital coronary arteriovenous fistulas were originated from the left coronary artery in six patients, right coronary artery in three patients, and the left circumflex artery in one patient. The drainage site of most CAVFs was the right ventricle, as expected and drainage to pulmonary artery (2) and right atrium (1) were other common anatomical locations, respectively. We followed the patients for the degree of shunt and for ongoing enlargement of coronary arteries for six months. Proper intervention for surgery or transcatheter occlusion was based on individual basis. Surgical ligation was the preferred management in three patients, as the anatomic features of fistulas were not appropriate for a catheter-based intervention. A catheter- based attempt for interventional closure was unsuccessful in a patient and underwent surgical ligation. Conclusion: Our study results suggest that it is important to diagnose CAVF in childhood due to the high risk of complications seen in adulthood, particularly, such as heart failure, myocardial ischemia, infective endocarditis and arrhythmias.

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