Coronary arteriovenous fistulas in the adults: natural history and management strategies

Abstract

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.

Percutaneous closure of congenital coronary artery fistulae in 5 children: A single center experience

“…Some authors reported that surgical treatment is very effective and safe. 5,[16][17][18] The fi rst successful surgical closure was reported by Biorck et al 19 After that there have been many series published up to 56 cases. Overall, mortality is low (~1%); single ligation is common; excision of fi stula is rare; and cardiopulmonary bypass is used in approximately one-half of the cases.…”

Coronary Artery Fistulas Between Coronary and Pulmonary Arteries: Case Reports

“…After the first decade, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium causing myocardial ischemia, thrombosis, embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias [1]. Clinical symptoms such as exertional angina or dyspnea are the primary indications for closure of a fistula.…”

“…Coronary artery fistula (CAF) are mostly abnormal congenital connections between a coronary artery and a cardiac or major intrathoracic vessel [1]. Coronary artery fistulas are rare with a 0.2% to 0.6% incidence in angiographic series.…”

Bilateral coronary artery to pulmonary trunk fistulae detected by coronary angiography and evaluated by ECG-gated SPECT myocardial perfusion imaging: report of two cases

“…Thus, symptoms and complications are less common in young patients, but the risk increases with age as the fistula enlarges. This may eventually lead to severe complications: myocardial ischaemia sudden cardiac death, endocarditis or secondary aortic and mitral valves dysfunctions [1,4,13].…”

“…The prevalence of this anomaly varies in literature, it is estimated that up to 0.4% of all congenital anomalies of the heart are CAF which are detected in up to 0.8% of patients undergoing coronary angiography [1,3,4,16].…”