摘要：Aims. Evaluate the results of diagnosis and surgical treatment of patients with congenital coronary artery fistulae (CAF) in combination with cardiac arrhythmias (CA). Material and methods. From May 2004 to September 2012 in Bakoulev SCCVS 75 CAF were revealed, 12 of which were accompanied by cardiac arrhythmias (6 men and 6 women). Atrial fibrillation and a trial flutter were present in 10 patients. AV nodal reentry tachycardia was observed in 1 patient. Wolf–Parkinson–White syndrome was diagnosed in 1 patient. The mean age of patients was 45,2 ± 16,9 years. Mean follow-up period was 12 ± 3 months. Results. Following anatomy of CAF were identified: drainage in to the pulmonary artery – 39 (51 %) cases, the right ventricle – 22 (29 %) cases, the right atrium – 10 (13 %) cases, the left atrium – 2 (2.6 %) cases, the left ventricle – 2 (2,6 %) cases, the coronary sinus – 1 (1,3%) case. It should be noted fistulae in 23 (59 %) patients didn’t cause any hemodynamic compromise (diameter of 2 mm, with no evidence of ischemia and heart failure). There were no deaths during in-hospital and long-term periods. There were also no myocardial ischemia and thromboembolic complications. Pacemaker implantation was performed in 2 patients after surgery due to sick sinus syndrome. Embolization or suturing of hemodynamically non-compromised fistulaes were not performed. Discussions. It may be concluded that heart failure as a result of hemodynamically compromised CAF leads to structural and electrical cardiac remodeling. These changes, in turn, often cause CA. Ventricular arrhythmias are predictors of ventricular myocardial electrical instability being the results of ischemia and ventricular volume overload. Planning of surgical treatment depends on concomitant cardiac pathology accompanied by congenital CAF. Combined arrhythmia surgery and correction of valvular pathology are recommended when closing of CAF in patients with AF, atriomegaly and relative insufficiency of the atrioventricular valves. Conclusion. Modern diagnostic methods and surgical repair allow effectively identify and eliminate CSF in combination with CA with a minimal risk of postoperative complications thereby improving long-term prognosis and quality of life. Coronary angiography and computed tomography are the main diagnostic methods allowing to examine CAF. Hemodynamically non-compromised CAF coincided with CA require a follow-up and, if necessary, surgical and/or medical therapy of CA. Main indications for embolization are proximal location and single CAF. Indications for surgical on-pump repair are concomitant cardiac pathology and relatively large and wide CAF.
