Pediatric coronary artery fistula: echocardiographic case reports and literature review of treatment strategy

BACKGROUND: Coronary artery fistula (CAF) is a rare cardiac anomaly. Application of transthoracic echocardiography (TTE) is not fully illustrated in pediatric period. Meanwhile, the treatment strategy of CAF is still a controversial issue. CASE PRESENTATION: Five cases of CAF with different types were presented. We also retrospectively reviewed 32 records of CAF in our institution from May 2001 to January 2015, including cardiac murmurs, symptoms, TTE diagnoses, complications, other anomalies, treatment and outcome. We summarized the most acceptable treatment strategy for pediatric patients. 71.9 % of all (23/32) had murmurs, 15.6 % of all (5/32) had symptoms. 24 patients received surgery or other imaging examination after TTE. 87.5 % of all (21/24) were correctly and accurately diagnosed by echocardiography, including pointing out the origin and outlet of CAF and complication. During the followup of all 32 patients, there was no spontaneous closure, heart failure, infective endocarditis or death case. CONCLUSIONS: TTE is a useful method that should be considered in the investigation and follow up of pediatric coronary artery fistula. The treatment strategy for pediatric patients should be individuation.