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The specifc details of the coronary artery are very impor- tant for designing an operation that will not place at risk a indicAtions For surgEry large area of viable myocardium supplied by the affected cor- onary artery distal to the fstula. This is particularly true of It is extremely unusual for coronary artery fstulas to be diag- coronary fstulas found in association with pulmonary atresia nosed early in life before a signifcant left to right shunt has with intact ventricular septum. The presence of any symptoms ure, which may have developed secondary to the volume or documentation of a measurable left to right shunt should load with or without associated myocardial ischemia. There who has an immeasurable shunt by oximetry remains to be is an important role for interventional catheter techniques, defned. Undoubtedly the availability of reliable and effective Anomalies of the Coronary Arteries interventional methods for coronary fstula closure has low- Identifcation of the fstulous orifce can be confrmed by ered the threshold for fstula closure. Some surgicAl mAnAgEmEnt prefer not to clamp the aorta but prefer to rely on blood fow History of Surgery through the fstula to identify it. Suture Ligation without Cardiopulmonary Bypass Coils were used in 28, umbrella devices in six and a Grifka If the fstula arises very distally e. There were no deaths or long-term assessment that no myocardium is at risk and that the thrill can morbidity. Excellent results for the surgical management of coro- Suture ligation has also been successfully employed nary artery fstulas have been described by several groups, when the fstula arises laterally from a main coronary trunk. In, Mavroudis et bypass is begun, care must be taken to avoid excessive runoff al.
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