Fetal coronary fistula

Prenatal diagnosis and perinatal management of left coronary
artery to right atrium fistula

G. MIELKE*, L. SIEVERDING†, T. BORTH-BRUNS†, K. EICHHORN‡, D. WALLWIENER* and
U. GEMBRUCH§

Departments of *Obstetrics and Gynecology and †Pediatric Cardiology, University of Tuebingen, ‡Medical Practice, Weimar and §Department of
Obstetrics and Gynecology, University of Luebeck, Germany

KEYWORDS: Coil embolization, Coronary artery fistula, Echocardiography, Fetal circulation, Fetal heart, Prenatal diagnosis
Ultrasound Obstet Gynecol 2002; 19: 612–615

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.