Standardization of operations for coronary to pulmonary artery fistulas

Abstract

Background: For coronary to pulmonary artery fistulas, operations are often indicated by the existence of myocardial ischemia or aneurysmal formations. Because lesions do not form in identical ways, a variety of surgical procedures are performed. We propose standardizing this operation for a safer and more reliable outcome. Methods: We evaluated 8 cases of operations for coronary to pulmonary artery fistulas. A concrete standard method for this operation was sought from the case results. Results: Standardization is summarized as: 1) Precise analysis of preoperative coronary angiography. 2) Thorough closure of fistulas and aneurysms. Cardiac arrest is preferred. 3) Perform as less pulmonary arteriotomy as possible. Use bicaval cannulation just in case of pulmonary arteriotomy. 4) During antegrade cardioplegic administration, oppress the fistulas to prevent stealing of solution. Use antegrade cardioplegia to confirm closure and hemostasis of fistulas and aneurysms. 5) Also use retrograde cardioplegia to ensure myocardial protection. Conclusions: Because there are variations among lesions of coronary to pulmonary artery fistulas, we propose some practical methods that can be applied in common to take account of such anomalies.