Spontaneous Closure of a Coronary Artery Fistula in Childhood

Abstract

Pulmonary stenosis diagnosed in infancy usually increases in severity with age or, if it is mild, may remain so for many years. We report the case of a child in whom moderately severe pulmonary stenosis in infancy appeared to completely resolve by the age of 8 years.

Case Details

Personal Characteristics

5-year-old female

Clinical Characteristics

Heart murmur, grade iii/vi continuous murmur, normal first heart sound, widely split second heart sound, palpable liver, cardiomegaly, increased pulmonary vascular markings, right ventricular hypertrophy, possible left ventricular hypertrophy, dilatation and tortuosity of the left circumflex and right coronary arteries, normal septal motion, normal sized distal coronary arteries

Remission Characteristics

Heart size within normal limits, decreased murmur intensity to grade ii/vi, normal electrocardiogram, no audible murmur, no demonstrable step-up in oxygen saturation, no shunt, evidence of residual mild dilatation and tortuosity, normal left ventricle size and function

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Follow-up, digoxin, endocarditis prophylaxis, cardiac catheterization, echocardiogram, aortic root angiogram

Additional Notes

The patient was first noted to have a heart murmur at age 5 months. The fistula was confirmed by angiography. By age 5 years, clinical evidence of the fistula was no longer present. Repeat cardiac catheterization confirmed spontaneous closure of the coronary artery fistula.