[Coronary artery fistulas, a current problem: Clinical and therapeutic considerations]

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Coronary fistulas, abnormal connections between coronary arteries and cardiac chambers or great vessels, have an unknown exact incidence.
• While often congenital, they can also arise post-cardiac surgery.
• Small fistulas are frequently asymptomatic, but symptoms and complications increase with age.

Observation:

• Potential complications include heart failure, arrhythmias, endocarditis, rupture, and thrombosis.
• Differential diagnosis involves distinguishing from patent ductus arteriosus and other arteriovenous shunts.
• Coronary angiography is the gold standard for anatomical description, though echocardiography aids in shunt differentiation.

Findings:

• Historically, surgical closure was the primary treatment for coronary fistulas.
• Percutaneous occlusion has emerged as the leading first-line therapy.
• Various devices allow tailored treatment based on fistula anatomy and function.

Implications:

• The shift towards percutaneous techniques offers less invasive options for managing coronary fistulas.
• Tailored device selection optimizes outcomes for patients with diverse coronary fistula presentations.
• Improved diagnostic and therapeutic strategies enhance the management of this rare cardiac anomaly.