Congenital coronary artery fistulas in adults: concomitant pathologies and treatment
Niyazi Cebi1, Norbert Schulze-Waltrup, Johannes Frömke
1Department of Thoracic and Cardiovascular Surgery, St-Johannes Hospital-Dortmund, Dortmund, Germany. niyazicebi@hotmail.com
Insights
Coronary artery fistulas are rare congenital heart defects incidentally found in adults. Closing these fistulas is recommended to prevent serious complications like heart attack and sudden death.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Coronary artery fistula is a rare congenital malformation.
- Potential complications include intracardiac shunts, endocarditis, myocardial infarction, aneurysm, and sudden death.
- This study reviews experience with concomitant cardiac pathologies and therapeutic approaches.
Purpose of the Study:
- To present experience with coronary artery fistulas and associated cardiac pathologies.
- To discuss surgical and percutaneous therapeutic interventions for coronary artery fistulas.
- To highlight the importance of closing coronary artery fistulas in adults.
Main Methods:
- 10 patients with incidentally diagnosed coronary artery fistulas (0.05%) were identified during 18,272 diagnostic cardiac catheterizations.
- Patient ages ranged from 42 to 76 years, with 3 females and 7 males.
- Preoperative functional status was assessed using New York Heart Association and Canadian Cardiovascular Society classifications.
Main Results:
- Coronary artery disease was present in 40% of patients; other anomalies included VSD, aortic regurgitation, and anomalous LAD origin.
- 40% of patients had isolated coronary artery fistulas.
- Surgical closure was performed in 70% and percutaneous closure in 30%, with no reported deaths or long-term morbidities.
Conclusions:
- Coronary artery fistulas are often incidentally diagnosed in adults during coronary angiography.
- Closure of coronary artery fistulas is crucial for preventing potential complications.
- Both surgical and percutaneous interventions are effective treatment options.
Background:
Coronary artery fistula is a rare congenital malformation. Complications such as intracardiac shunts, endocarditis, myocardial infarction, aneurysm and sudden death can be observed. The purpose of this article is to present our experience with concomitant cardiac pathologies and discuss various therapeutic approaches including surgical and percutaneous intervention.
Materials And Methods:
During 18,272 diagnostic cardiac catheterizations, coronary artery fistulas were identified incidentally in 10 patients (0.05%). There were 3 female and 7 male patients. The patients' ages ranged from 42 to 76 years. All patients with coronary artery fistula were preoperatively in New York Heart Association functional class and Canadian Cardiovascular Society class II or III.
Results:
In addition to coronary artery fistula, coronary artery disease was detected in 4 patients (40%), a ventricular septal defect and an aneurysm of the sinuses of Valsalvae with aortic regurgitation in one patient (10%) and an anomalous origin of the LAD from the pulmonary trunk in one patient (10%) during cardiac catheterization. Four (40%) of the total of 10 patients had only coronary artery fistula. Surgical closure of the coronary artery fistula was performed in 7 patients (70%). An interventional fistula closure with a coil device was confirmed by cardiac catheterization in another 3 patients (30%). One patient of the latter group showed a small residual shunt from the LAD to the pulmonary trunk. No death or long-term morbidities could be observed.
Conclusions:
Coronary artery fistulas are incidentally diagnosed during coronary artery angiographies in adults and should be closed to prevent complications.
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