Coronary-cameral fistulas in adults: Acquired types (second of two parts)

Abstract

Acquired coronary artery fistulas (CCFs) are infrequently detected during conventional coronary angiography. To delineate the characteristics of congenital (first part) and acquired (second part) CCFs in adults, a PubMed search was conducted for papers dealing with congenital or acquired CCFs. None of the publications describing patients with coronary-vascular fistulas were included. Papers dealing with pediatric subjects were excluded. From the world literature, a total of 243 adult patients were selected who had congenital (n = 159/243, 65%) and acquired (n = 84/243, 35%) CCFs. Among the acquired types (n = 72, 85.7%) were traumatic (iatrogenic (n = 65/72, 90%), accidental (n = 7/72, 10%) and (n = 12, 14.3%) spontaneously developing in relation to severe coronary atherosclerosis or myocardial infarction. A high incidence of spontaneous resolution of iatrogenic CCFs resulting from endomyocardial biopsy or following post-septal myectomy was reported. Spontaneous CCFs associated with myocardial ischemia or infarction resolved completely in 8% of the subjects. Early surgical intervention was the treatment of choice in acquired traumatic accidental CCFs. The congenital types are addressed in a previous issue of this journal (first part). In this review (second of two parts, part II), we describe the acquired coronary-cameral fistulas.

A rare case of left atrial myxoma vascularity causing acquired coronary cameral fistula: Role of transesophageal echocardiography

“…Traumatic fistulas are further subdivided into iatrogenic and accidental subtypes. [ 6 ] CCF most commonly arises from RCA (50%–55%) followed by 35% from LCA and 5% from both coronaries. More than 90% of fistulas open into right heart chambers and about 8% of fistula drain into left heart chambers.…”

Acquired Coronary Cameral Fistula Due to Post Stent Balloon Dilatation: Dual Coronary Artery Perforations into the Left Ventricle—What Is the Right Treatment?

“…Previous studies in coronary cameral fistulas have revealed that traumatic coronary artery-cameral fistulas (TCAF) resulting from penetrating cardiac trauma are highly lethal, and require early surgical intervention [8]. In comparison, iatrogenic traumatic acquired coronary artery cameral fistulas (CCF) (such as those from stent placement in a chronic total occluded vessel) and spontaneously acquired CCF (which develop post-MI) have low flow, and can be treated with supportive medical management [9]. There have been case reports of spontaneous closure of cavity spilling perforation after PCI [8] [9].…”

“…In comparison, iatrogenic traumatic acquired coronary artery cameral fistulas (CCF) (such as those from stent placement in a chronic total occluded vessel) and spontaneously acquired CCF (which develop post-MI) have low flow, and can be treated with supportive medical management [9]. There have been case reports of spontaneous closure of cavity spilling perforation after PCI [8] [9]. Therefore it seems reasonable to treat large and moderate sized coronary perforations into the left ventricle while reserving a conservative strategy for smaller ones.…”

Dose All of the Coronary Fistulas been Created by the Reopening Wire After Successful Revascularization of Chronic Total Occlusion?

“…Procedural success was de ned as < 50% residual stenosis with antegrade TIMI ow grade 3 at the end of the procedure [8]. ACF was de ned as an abnormal connection between coronary arteries and cardiac chambers or with other vessels, which are secondary to exogenous or endogenous injury [1]. History of myocardial infarction was identi ed by past medical record including STsegment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) based on initial ECG, and clinical and laboratory ndings.…”

“…Coronary stulas rst described as congenital and abnormal vascular connections between coronary arteries and cardiac chambers or with other vessels, were later found to have other etiologies [1], including trauma, surgery, severe coronary atherosclerosis and myocardial infarction (MI). As rst reported by Ryan in 1977 [2] and later by others [3][4][5], MI is a common cause of acquired coronary stulas (ACFs).…”