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Coronary artery fistulas: long-term results of surgical correction
D L Cheung1, W K Au, H H Cheung
1Department of Surgery, The University of Hong Kong, Grantham Hospital, Aberdeen. dlcheung@netvigator.com
Insights
Surgical intervention for coronary artery fistula is recommended for all patients with demonstrable shunting due to minimal risks. Long-term follow-up is crucial for monitoring residual or recurrent fistulas.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Debate exists regarding surgical intervention for coronary artery fistulas, especially in asymptomatic individuals.
- Limited long-term follow-up data in existing studies contributes to varied clinical opinions.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical intervention for coronary artery fistula.
- To provide evidence-based recommendations for managing coronary artery fistulas.
Main Methods:
- A retrospective study of 41 patients who underwent surgery for coronary artery fistula over 30 years.
- Coronary angiograms were performed for restudies in consenting patients.
Main Results:
- No operative mortality and low operative morbidity were observed.
- Mean follow-up was 9.1 years, with 96.9% of patients remaining asymptomatic.
- Post-angiogram findings included dilated/tortuous native arteries or thromboses; no myocardial ischemia was noted. Four patients had recurrent fistulas without hemodynamic compromise.
Conclusions:
- Operation is advocated for all coronary artery fistulas with demonstrable shunting due to minimal risks.
- Small asymptomatic fistulas without shunting may be managed conservatively.
- Mandatory long-term follow-up is essential due to the notable incidence of residual or recurrent fistulas.
Background:
Opinions vary as to whether operation should be offered patients with coronary artery fistula, particularly to those who are asymptomatic. Published studies lacked long-term follow-up data.
Methods:
We studied 41 patients with coronary artery fistula operated in our unit in the past 30 years with restudies including coronary angiograms in those who agreed to the investigation.
Results:
There was no operative mortality and operative morbidity was low. The mean duration of follow-up was 9.1 years and 96.9% of the patients were asymptomatic. Twenty-one patients had a coronary angiogram. The native coronary artery either remained dilated and tortuous, or more frequently had thromboses with a short proximal stump. (None of these patients had evidence of myocardial ischemia.) Four patients had demonstrable recurrence fistula but without hemodynamic disturbance.
Conclusions:
We advocate operation for all patients with coronary artery fistulas and demonstrable shunting in view of minimal operative risks. Small asymptomatic fistulas without demonstrable shunting should be left alone. The relatively high incidence of residual or recurrent fistula makes long-term follow-up mandatory.