Echocardiographic diagnosis of coronary fistulas in children with murmur above the heart area

N. F. Priyma, D. O. Ivanov, Yu V. Petrenko

Research output: Contribution to journalArticlepeer-review

Abstract

The objective. Based on the findings of routine echocardiographic examination to determine the incidence of coronary fistulas in children with murmur above the heart area; to reveal Doppler differential-diagnostic signs of coronary-pulmonary fistulas; to analyse medical history data and specific complaints of children with verified coronary artery fistulas. Patients and methods. Outpatient echocardiographic examination was performed in 1503 children aged 1 day of life to 18 years inclusive. Of them 839 were boys (mean age = 6.7 ± 5.5 years), 664 girls (mean age = 6.2 ± 5.2 years). In all children systolic murmur was recorded above the heart area. We used ultrasound scanners Sonas SA 9900 and Vivd-7 Pro with 2.5 MHz cardiac transducer. Examinations were performed according to standard methodologies. Results. Routine echocardiography detected coronary fistulas in 35 (2.3%) children and found sites of their drainage; all fistulas were regarded as distal. In 31 children, single fistulas were found, in 4-multiple, and in 2 of them bilateral; in 14 (40%) cases fistulas originated from the basin of the left coronary artery, in 21 (60%)-from the right one. The children's mean age was 8.8 ± 6.5 years. In 19 cases, fistulas drained into the trunk and orifice of the pulmonary artery (coronary-pulmonary). The pulse-wave mode of Doppler mapping permitted to find an important sign allowing a differential diagnosis between fistulas draining into the orifice of the pulmonary artery and the patent arterial duct (PAD). Diastolic shunts through a fistula are very short, unequal in time and arise in the second phase of diastole, whereas a PAD diastolic shunt fills the whole diastole. Also, unlike the coronary-pulmonary fistula, PAD can be distinctly seen from the side of the aortic arch transition to its descending part vizualized using the suprasternal approach. As has been also found, 8 of 11 children with documented fistulas between the coronary artery and ventricles of the heart had some or other cardiological complaints. Conclusion. Routine echocardiography in children permits to diagnose coronary fistulas draining into any heart cavity. Two criteria have been found that permit to make a differential diagnostics between distal coronary-pulmonary fistulas and PAD. Study of specificities of blood flow in childhood presupposes further accumulation of evidence and their comprehension.

Original languageRussian
Pages (from-to)48-54
Number of pages7
JournalVoprosy Prakticheskoi Pediatrii
Volume10
Issue number6
StatePublished - 1 Jan 2015

Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Keywords

  • Children
  • Coronary artery fistulas
  • Doppler mapping
  • Echocardiography
  • Pulse-wave mode

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