Coronary Artery Fistulas: Case Report and Review of Literature

Abstract

Congenital coronary artery fistula is a very rare malformation that may involve any or all coronary artery branches and any cardiac chamber. Elective closure of coronary artery fistulas by surgery or percutaneous transcatheter techniques is generally accepted in the presence of symptoms, but controversies exist in the management of asymptomatic patients. We describe a case where a fistulous communication was present between the proximal left anterior descending coronary artery and the pulmonary artery and provide a review of the available literature concerning management of patients with coronary artery fistulas.

Angiographic and Clinical Manifestations of Coronary Fistulas in Chinese People 15-Year Experience

“…HF was also detected in 19 patients, but 17 of them had overt underlying heart disease (eg, VHD, CHD, DCM etc) and CAF-related HF may have occurred in 2 patients with only CAFs. In the previous reports, [1][2][3][4][5][6][7][8]16,17 CAFs rarely coexist with other congenital anomalies, whereas in our study, CAF was not uncommonly (24 patients, 19%) coexisting with different congenital anomalies. Although most CAFs are congenital, acquired CAF may also occur, especially after cardiac or thoracic surgery, chest trauma, or device deployment in the cardiovascular system.…”

“…Congenital CAFs often arise from the RCA system and drain into the right heart chamber or into the PA. [1][2][3][4] Left CAFs are reportedly less frequently seen, [1][2][3][4][5][6][7][8]16,17 but in the present study left-side CAFs represented more than half (106/152, 70%) of the patients. Bilateral fistulas are even more rare, occurring in only 5% of all patients in previous reports.…”

“…Bilateral fistulas are even more rare, occurring in only 5% of all patients in previous reports. [1][2][3][4][5][6][7][8]16,17 In the present series, 26 of 125 (21%) patients had bilateral and/or multiple fistulas. Nearly all previous reports are from Caucasians and our study is the first report of Oriental patients with long-term follow-up and with a large number of patients.…”

“…Although most CAFs are congenital, acquired CAF may also occur, especially after cardiac or thoracic surgery, chest trauma, or device deployment in the cardiovascular system. [5][6][7][8]16,17 In our study, follow-up found 2 cases of disease progression without any external injury and a LAD -LAA thrombus fistula in a patients with MS, which may be another interesting example of acquired CAF. Another important issue is the difference between the 2 types of CAFs.…”

“…1,5,7,8 Other symptoms include fatigue, HF, pulmonary hypertension, rupture or thrombosis of the fistula, atrial arrhythmia, and AP. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In patients presenting with AP, most are older than 40 years of age and most have coexistent coronary artery stenosis and/or had large or multiple fistulas. Coexistent coronary stenosis or MI were detected in 42 (34%) of the present patients and 34 (25%) underwent PCI or CABG.…”