[Prevalence and clinical features of microfistulas between the coronary artery and left ventricle: single-center
Mehmet Doğan1, Hamza Sunman1, Ahmet Akyel1
1Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Objectives:
Coronary artery fistula is an infrequent malformation, and the prevalence was reported as approximately 0.1-0.4% in previous studies. However, the number of studies about microfistulas from coronary arteries to the left ventricle is inadequate, especially in the Turkish population. The purpose of this study was to evaluate the prevalence and clinical features of microfistulas in subjects undergoing coronary angiography for the assessment of coronary artery disease.
Study Design:
In this retrospective study, we researched the cardiac catheterization laboratory database between January 2008 and July 2013. The presence of microfistulas was established according to the following criteria: 1) direct filling of the heart cavity during selective coronary injection without interposing "capillary" phase or venous filling, and 2) visualization of small vessels interposed between the epicardial coronary vessels and the heart cavity and emptying into the heart.
Results:
Microfistulas were found in 12 (0.11%) of the 11403 coronary angiographies. There were 7 (58.3%) female patients (mean age, 70.2±10.8 years), and contemporary severe coronary artery stenosis was noted in 2 (16.7%) patients. Chest pain was the most frequently encountered complaint, followed by dyspnea. Microfistulas originated from the left anterior descending artery (100%), circumflex artery (66.7%), and right coronary artery (58.3%). In addition, multiple microfistulas were seen in 6 (50%) patients, bilateral microfistulas in 3 (25%) patients and unilateral microfistula in 3 (25%) patients, and all of them terminated in the left ventricle.
Conclusion:
Our study found an overall incidence of microfistulas of 0.11%. Microfistula is a rare cardiac anomaly that sometimes causes cardiac symptoms; otherwise, it is detected during routine coronary angiography.
Insights
Coronary microfistulas, rare cardiac anomalies, were found in 0.11% of patients undergoing coronary angiography. These fistulas, often asymptomatic, originate from major coronary arteries and empty into the left ventricle.
Area of Science:
- Cardiology
- Vascular Malformations
Background:
- Coronary artery fistulas are uncommon congenital heart defects.
- Previous studies report a prevalence of 0.1-0.4%, with limited data on microfistulas to the left ventricle, particularly in the Turkish population.
Purpose of the Study:
- To determine the prevalence and clinical characteristics of coronary artery microfistulas.
- To investigate microfistulas in patients undergoing coronary angiography for coronary artery disease assessment.
Main Methods:
- Retrospective analysis of cardiac catheterization data from January 2008 to July 2013.
- Defined microfistulas by direct cardiac cavity filling without a capillary phase and visualization of small vessels connecting epicardial coronaries to the heart.
Main Results:
- Microfistulas were identified in 12 (0.11%) of 11,403 coronary angiographies.
- The majority of affected patients were female (58.3%), with a mean age of 70.2 years. Chest pain and dyspnea were common symptoms.
- Microfistulas originated from the left anterior descending, circumflex, and right coronary arteries, frequently terminating in the left ventricle.
Conclusions:
- The study established an incidence of 0.11% for coronary microfistulas.
- Coronary microfistulas are rare cardiac anomalies, occasionally symptomatic, and often discovered incidentally during coronary angiography.
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