Int J Angiol 2021; 30(04): 277-284
DOI: 10.1055/s-0041-1727134
Original Article

Coronary Artery Fistulae in Adult: Two Decades of Experience in Clinical Presentation, Angiographic Feature, and Management

Tuncay Taskesen
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Kofi Osei
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Russell Hamilton
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Justin Ugwu
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Daniel Shivapour
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Mark Tannenbaum
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
,
Magdi Ghali
1   Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
› Institutsangaben
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Abstract

Coronary artery fistula (CAF) in adults is a rare but significant coronary artery anomaly. Main data on that rare disease were mostly obtained from case reports and small studies. In presented study, we share our two-decade experience on the clinical and angiographic characteristics of CAF.

The data were collected retrospectively by analyzing the angiographic data between January 1, 2000 and December 31, 2019. Demographic data, clinical data, laboratory, and cardiac catheterization reports were reviewed.

CAFs were found in 40 patients (0.06%). There were 22 male (55%) patients. The mean age was 61.2 years. Twenty-nine patients (72.5%) had small, 4 patients (10%) had medium, and 7 patients (17.5%) had large CAFs. The majority of study population had solitary CAF (n = 31, 77.5%). The pulmonary artery is the major side of fistula drainage (n = 20, 50%). The study population was divided into two groups as follow: group 1—small CAFs 29 (72.5%), group 2—medium and large CAF (MLCAF) 11 (27.5%). Patients with MLCAFs had more atrial fibrillation, abnormal coronary morphology, and multiple fistulae. In patients with hemodynamically significant CAFs, 7 (17.5%) patients had surgical ligation and 3 (7.5%) patients had transcutaneous closure. Three patients died during mean follow-up period of 5 years.

The incidence and the pattern of CAFs in our study were similar to previous studies. Clinical course of small fistulae was benign. Symptomatic MLCAFs need to be treated by transcatheter or surgical way and should be individualized per patient.



Publikationsverlauf

Artikel online veröffentlicht:
10. November 2021

© 2021. International College of Angiology. This article is published by Thieme.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 W. K. Uber den ursprung einer akzessorischen A. coronaria aus der a. pulmonalis. Z Ratl Med 1865; 24 (24) 225-227
  • 2 Ata Y, Turk T, Bicer M, Yalcin M, Ata F, Yavuz S. Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg 2009; 4: 62
  • 3 Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. . The Int J Angiol 2014; 23 (01) 1-10
  • 4 Warnes CA, Williams RG, Bashore TM. et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52 (23) e143-e263
  • 5 Reddy G, Davies JE, Holmes DR, Schaff HV, Singh SP, Alli OO. Coronary artery fistulae. Circ Cardiovasc Interv 2015; 8 (11) e003062
  • 6 Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21 (01) 28-40
  • 7 Said SA, van der Werf T. Dutch survey of coronary artery fistulas in adults: congenital solitary fistulas. Int J Cardiol 2006; 106 (03) 323-332
  • 8 Valente AM, Lock JE, Gauvreau K. et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv 2010; 3 (02) 134-139
  • 9 Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary artery fistulae: anatomy, diagnosis and management strategies. Heart Lung Circ 2018; 27 (08) 940-951
  • 10 Fernandes ED, Kadivar H, Hallman GL, Reul GJ, Ott DA, Cooley DA. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg 1992; 54 (04) 732-740
  • 11 Calkins Jr JB, Talley JD, Kim NH. Iatrogenic aorto-coronary venous fistula as a complication of coronary artery bypass surgery: patient report and review of the literature. Cathet Cardiovasc Diagn 1996; 37 (01) 55-59
  • 12 Mangukia CV. Coronary artery fistula. Ann Thorac Surg 2012; 93 (06) 2084-2092
  • 13 Pan YY, Chen G, Chen B. et al. Prevalence of coronary artery fistula in a single center of China. Chin Med J (Engl) 2018; 131 (12) 1492-1495
  • 14 Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol 2014; 203 (03) W237-43
  • 15 Canga Y, Ozcan KS, Emre A. et al. Coronary artery fistula: review of 54 cases from single center experience. Cardiol J 2012; 19 (03) 278-286
  • 16 Ali M, Kassem KM, Osei K, Effat M. Coronary artery fistulae. J Thromb Thrombolysis 2019; 48 (02) 345-351
  • 17 Gowda RM, Vasavada BC, Khan IA. Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 2006; 107 (01) 7-10
  • 18 Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistulae. Am J Med Sci 2006; 332 (02) 79-84
  • 19 Tuncer C, Eryonucu B, Batyraliev T. et al. Angiographic characteristics of coronary artery fistulas. Turk Kardiyol Dern Ars 2014; 42 (05) 456-460
  • 20 Albeyoglu S, Aldag M, Ciloglu U. et al. Coronary arteriovenous fistulas in adult patients: surgical management and outcomes. Rev Bras Cir Cardiovasc 2017; 32 (01) 15-21
  • 21 Said SA. Current characteristics of congenital coronary artery fistulas in adults: a decade of global experience. World J Cardiol 2011; 3 (08) 267-277
  • 22 Sunkara A, Chebrolu LH, Chang SM, Barker C. Coronary artery fistula. Methodist DeBakey Cardiovasc J 2017; 13 (02) 78-80
  • 23 Kochar A, Kiefer T. Coronary artery anomalies: when you need to worry. Curr Cardiol Rep 2017; 19 (05) 39
  • 24 Kiefer TL, Crowley AL, Jaggers J, Harrison JK. Coronary arteriovenous fistulae: the complexity of coronary artery-to-coronary sinus connections. Tex Heart Inst J 2012; 39 (02) 218-222
  • 25 Bruckheimer E, Harris M, Kornowski R, Dagan T, Birk E. Transcatheter closure of large congenital coronary-cameral fistulae with Amplatzer devices. Catheter Cardiovasc Interv 2010; 75 (06) 850-854
  • 26 Said SM, Burkhart HM, Schaff HV. et al. Late outcome of repair of congenital coronary artery fistulas--a word of caution. J Thorac Cardiovasc Surg 2013; 145 (02) 455-460