Congenital coronary artery fistulas in adults: concomitant pathologies and treatment

Çebi, Niyazi; Schulze‐Waltrup, Norbert; Frömke, Johannes; Scheffold, Thomas; Heuer, H.

doi:10.1007/s10554-007-9277-x

Cited by 39 publications

(42 citation statements)

References 8 publications

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“…Elective ligation in childhood has been recommended because of increasing incidence of late symptoms and complications in older patients. 1,2 Despite passage of 50 and 25 years from first reports of successful surgical ligation 3 and transcatheter closure (TCC), 4,5 respectively, of coronary fistulae, few descriptions exist of intermediate or long-term outcome from such interventions.…”

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confidence: 99%

Predictors of Long-Term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae

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Gauvreau

et al. 2010

Circ: Cardiovascular Interventions

117

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Background— Significant morbidities, including angina, symptomatic heart failure, and myocardial infarction, have been reported after coronary artery fistula (CAF) closure; however, predictors that may be associated with adverse outcomes have not been established. The goal of this investigation is to describe the long-term outcomes witnessed in patients with either treated or untreated CAF at our institution and to investigate whether certain features predicted adverse outcomes. Methods and Results— The records and angiograms of patients with CAF who underwent a diagnostic cardiac catheterization at Children’s Hospital Boston from 1959 through 2008 were reviewed. Of 76 patients identified, 20% were associated with additional congenital heart disease. Forty-four underwent transcatheter closure, 20 underwent surgical repair, and no intervention was performed in the remaining 12 subjects. Three patients who had initially undergone surgical closure had a second intervention, 1 underwent repeat surgery, and 2 underwent transcatheter closure. One patient who had undergone transcatheter closure underwent a second transcatheter closure for residual fistula. Major complications, including myocardial infarction, angina with coronary thrombosis, and symptomatic cardiomyopathy, occurred in 11 (15%) patients. The sole angiographic feature that was predictive of adverse outcome was drainage of the CAF into the coronary sinus ( P <0.001). Clinical predictors associated with adverse outcomes included older age at diagnosis ( P <0.001), tobacco use ( P =0.006), diabetes ( P =0.05), systemic hypertension ( P <0.001), and hyperlipidemia ( P <0.001). Conclusions— Long-term complications of CAF closure may include coronary thrombosis, myocardial infarction, and cardiomyopathy. CAF that drain into the coronary sinus are at particularly high-risk of long-term morbidities after closure, and strategies including long-term anticoagulation should be considered.

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confidence: 99%

Predictors of Long-Term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae

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Gauvreau

et al. 2010

Circ: Cardiovascular Interventions

117

103

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“…Because of the low prevalence of coronary artery fistulas, the optimal management remains unclear and there are no established therapeutic guidelines. Treatment with percutaneous intervention or surgery is recommended for patients with symptoms such as chest pain and dyspnea (4,10,15,(18)(19)(20) and to prevent the development of heart failure (4-7), myocardial ischemia (4, 6, 8-10), endocarditis (11) or rupture of aneurysmal vessels (12)(13)(14). Cebi et al indicated that symptomatic coronary artery fistulas should be closed irrespective of the size of the left-to-right shunt (4).…”

Section: Discussionmentioning

confidence: 99%

“…A coronary artery fistula is a relatively rare anomaly, observed as an incidental finding on 0.05-0.2% of coronary angiograms (1)(2)(3)(4). Coronary artery fistulas can result in heart failure (4-7), myocardial ischemia (4,6,(8)(9)(10), endocarditis (11) and rupture of aneurysmal vessels (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

“…Coronary artery fistulas can result in heart failure (4-7), myocardial ischemia (4,6,(8)(9)(10), endocarditis (11) and rupture of aneurysmal vessels (12)(13)(14). The majority of coronary artery fistulas originate from the right coronary artery or left anterior descending artery (LAD) and connect with a pulmonary artery, pulmonary vein, cardiac chamber, coronary sinus or the vena cava (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

“…The majority of coronary artery fistulas originate from the right coronary artery or left anterior descending artery (LAD) and connect with a pulmonary artery, pulmonary vein, cardiac chamber, coronary sinus or the vena cava (15)(16)(17). Symptomatic coronary artery fistulas should be treated with percutaneous intervention or surgery (4,10,15,(18)(19)(20). We herein report a case of successful percutaneous coil embolization of a large and anatomically complex coronary artery to pulmonary artery fistula.…”

Section: Introductionmentioning

confidence: 99%

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Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

et al. 2013

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We herein report the case of a 73-year-old woman with a large and tortuous coronary artery to pulmonary artery fistula treated with percutaneous coil embolization. The patient was hospitalized due to unstable angina with an elevated serum troponin-T level. Coronary angiography revealed no significant atherosclerotic stenosis, with a large and tortuous coronary artery to pulmonary artery fistula originating from the proximal portion of the left anterior descending artery. We successfully performed percutaneous coil embolization of the fistula. In this case, 320-slice multidetector computed tomography played a pivotal role in the diagnosis and percutaneous intervention.

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Coronary Arterial Fistula

2009

The Natural and Unnatural History of Congenital Heart Disease

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Congenital coronary artery fistula is a rare abnormality in which a branch of either coronary artery communicates with a cardiac chamber or with the pulmonary trunk. Recently Papaioannou and his colleagues (1962) reviewed 70 adequately documented cases, including one of their own; in 18 of these a branch of the right coronary artery entered the right ventricle. A further patient with this anomaly is described here, with observations on the problem of diagnosis and a possible surgical approach to the correction of the lesion. Case ReportA man, aged 31 when he died, was first seen at this hospital in 1957 six years previously, when he was admitted for a hernia operation. He had been attending a physician elsewhere and was known to have congenital heart disease, which was then symptomless. At no time did he have a continuous murmur.On examination, he had a collapsing pulse with capillary pulsation and a wide pulse pressure (blood pressure 150/45 mm. Hg). There was no cyanosis or clubbing and the venous pressure was normal. The heart was very large with hypertrophy of both ventricles. There was a very loud pan-systolic murmur, with thrill, maximal in the third intercostal space to the left of the sternum, an apical mid-diastolic murmur, and a soft blowing early-diastolic murmur down the left border of the sternum. The second sound was normally split. The electrocardiogram showed left ventricular hypertrophy, without ST or T wave changes but with notching of the R wave in leads I and V6 (Fig. la). On the chest radiograph there was enlargement of aorta and pulmonary trunk, and considerable pulmonary plethora. At cardiac catheterization, a large left-toright shunt at ventricular level was demonstrated (pulmonary/systemic flow ratio approximately 4:1), the pulmonary arterial pressure was slightly raised (35/7 mm. Hg above the sternal angle), and the pulmonary vascular resistance was normal. He was thought to have a ventricular septal defect with aortic regurgitation, but the discrepancy between the width of the pulse pressure and the inconspicuous early diastolic murmur was noted. Operation was not advised as he was then symptomless and as the presence of presumably free aortic reflux would have posed problems which at that time were insuperable.He was not seen again until five years later when he returned with increasing effort dyspncea and palpitation, and was found to have atrial fibrillation, with clinical and radiological evidence of pulmonary congestion. The signs were otherwise unchanged (phonocardiogram shown in Fig. lc), but the electrocardiogram now showed evidence of right ventricular hypertrophy (Fig. lb). The blood pressure was 170/30 mm. Hg. In spite of treatment his condition deteriorated, and he was readmitted to hospital with right and left ventricular failure, pulmonary infarction, and secondary chest infection. He never improved sufficiently for further investigations to be undertaken, and he died in May 1963.At necropsy (Dr. W. J. Hanbury) there was peripheral cedema, with pleural, pericardial, and p...

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Congenital coronary artery fistulas in adults: concomitant pathologies and treatment

Abstract: Coronary artery fistulas are incidentally diagnosed during coronary artery angiographies in adults and should be closed to prevent complications.

Cited by 39 publications

References 8 publications

Predictors of Long-Term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae

Predictors of Long-Term Adverse Outcomes in Patients With Congenital Coronary Artery Fistulae

Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

Coronary Arterial Fistula

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