Objective: To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies. Methods:Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 ± 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography Results: All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients. Conclusion:Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.

The aim of this study was to evaluate and compare the dentofacial effects of 1 week rapid palatal expansion (RPE) and activation-deactivation (A/D) RPE protocols with reverse headgear (RH). Two groups, each containing 15 subjects, were included in this study. In the RPE group (seven males and eight females, 11.94 ± 1.62 years), Hyrax screws were activated every 12 hours for 1 week. At the end of this period, RPE was stopped and the patients were instructed to wear the RH. In the A/D-RPE group (seven males and eight females, 11.34 ± 1.81 years), the screws were activated every 12 hours for 1 week. Subsequently, the screws were deactivated every 12 hours for 1 week followed by activation and deactivation for the following 2 weeks. After this protocol, the patients were instructed to use the RH. A total force of 700 g was applied to both groups for 16-18 hours/day for the first 3 months, for 12 hours/day for the second 3 months, and for 6 hours/day for the second 6 months. Lateral cephalometric films were taken before treatment (T1) and at the end of the first (T2) and second (T3) 6 months to evaluate the dentofacial changes. Intragroup differences of each landmark at T2-T1, T3-T2, and T3-T1 were analysed with a paired t-test (P < 0.016), and intergroup differences were compared with an independent t-test (P < 0.05). Anterior movement of point A (4.13 mm) for the A/D-RPE group was approximately twice of the RPE group (2.33 mm; P < 0.001). Backward movement of the mandible showed no significant difference between the groups. Anterior face height increases did not demonstrate significant differences between the groups. The pronounced anterior movement of point A demonstrates that the A/D-RPE procedure positively affects maxillary protraction.

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