Anomalous Coronary Arteries/Fistulas
Treatment
Surgical procedures
Coronary arteries arising from an abnormal place may require surgical reimplantation. However, not all anomalous coronary arteries require surgery if it’s determined that the blood flow to the heart isn’t at risk. In some situations, it can be very difficult to determine the overall risk of sudden death in a patient with anomalous coronary arteries. Many coronary artery fistulas may spontaneously go away over time. Large coronary artery fistulas may be blocked (occluded) in the catheterization lab. The child's care team may use special metallic coils or devices to fill the abnormal vessel, or the team may require surgical closure (ligation). If the heart has sustained severe damage, cardiac transplantation may be the only option.
Medications
Medications used to treat anomalous coronary arteries/fistulas include the following:
- Diuretics – The most commonly prescribed diuretics are furosemide (Lasix) and thiazides (Diuril and Hydrodiuril). Diuretics cause the child to pass more urine, leading to a smaller blood volume—and a smaller burden on the heart to pump. Another commonly used diuretic is spiranolactone (Aldactone). It has a weak diuretic effect and is mainly used because it helps the kidneys retain potassium. Other diuretics tend to waste potassium excessively. Spironolactone may also help with heart remodeling via mechanisms that are not completely known yet.
- Inotropes – These medications, which include digoxin, help the heart pump more efficiently (stronger while using less energy).
- Afterload-reducing agents – Many of the medications in this category end with the suffix “pril.” These drugs, which include captopril, are sometimes used in the treatment of congestive heart failure, as they help blood flow to the body and tissues. They may also help with heart remodeling via mechanisms that are not completely known yet.
- Beta blockers – Many of the medications in this category end with the suffix “olol.” These medications may help to regulate the stress response of the body to congestive heart failure (neurohormonal regulation).