Coronary-Pulmonary Artery Fistulas: A Systematic Review

Area of Science:

• Cardiology
• Radiology
• Congenital Heart Disease

Background:

• Coronary-pulmonary arterial fistulas (CPAFs) are rare coronary artery anomalies.
• Limited case reports exist, necessitating a broader analysis of trends.

Purpose of the Study:

• To evaluate the clinical presentation and imaging findings of CPAFs.
• To identify general trends in CPAFs by combining multi-center data and literature review.

Main Methods:

• Retrospective analysis of 25 CPAF cases diagnosed via coronary computed tomography angiography from 6 institutions.
• Inclusion of 78 additional CPAF cases from a PubMed literature search.
• Review of imaging findings and clinical history for all 103 cases.

Main Results:

• The study analyzed 103 CPAF patients (63% male, age range newborn to 88 years).
• Common symptoms included chest pain (39%) and dyspnea (25%); a murmur was the most frequent physical finding (37%).
• Most CPAFs originated from the left main/LAD (84%) and terminated in the main pulmonary artery (89%). Multiple CPAFs occurred in 45% of cases, and coronary artery aneurysms in 19%.

Conclusions:

• CPAFs present across diverse clinical settings, from infants with congenital heart disease to adults post-revascularization.
• Contrary to previous literature, this series highlights the common occurrence of multiple CPAFs.
• The predominant pattern observed was fistulas between the left main/LAD and the main pulmonary trunk.