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[Left coronaro-ventricular microfistula]
Abstract:
Microfistulae between coronary arteries and left ventricle have long been regarded as mere curiosities, but their frequency seems to have been underestimated. A review of 2,520 consecutive coronary arteriographies performed in adults has yielded 34 cases. In most of the 28 patients without infarction or valve disease, the symptoms were suggestive of coronary pathology. Signs of ischaemia were found at electrocardiography in 19 of these 28 patients, and exercise tests or myocardial scintigraphy were positive in 2 out of 3 cases. Patients' mean age was 53.4 years. The coronary arteriographic diagnosis was usually easy when technical conditions were perfect. The division of patients into two groups according to the presence or absence of significant coronary lesions revealed that the "isolated microfistulae" group was primarily composed of women (19/21). It is generally accepted that these fistulae are of embryonic origin, but their relation to atherosclerosis needs to be determined. The causes of ischaemic manifestations (coronary artery steal, global disturbances of myocardial microcirculation) are considered. Treatment is essentially medical, surgery being exceptional. Prognosis is habitually favourable (mean follow-up 28.3 months in our series). Thus, microfistulae between coronary arteries and left ventricle usually present as angina-like symptoms in women in their fifties who are free from atheromatous disease. They are found in more than 1 p. 100 of coronary arteriographies in adults, i.e. 8 p. 100 of "normal" coronary arteriographies. Their origin, the mechanisms of their symptoms and their relationship with the "so-called healthy coronary arteries angina" are obscure.
Insights
Coronary artery microfistulae, often overlooked, are found in over 1% of adult coronary arteriographies. These anomalies frequently cause angina-like symptoms in women without significant coronary artery disease, suggesting a distinct clinical entity.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Context:
- Coronary artery microfistulae are rare vascular anomalies.
- Their clinical significance and prevalence have been underestimated.
- This study investigates their presentation and characteristics in adult patients.
Purpose:
- To determine the frequency of coronary artery to left ventricle microfistulae.
- To characterize the clinical presentation, diagnostic findings, and patient demographics.
- To explore potential etiologies and mechanisms of symptoms.
Summary:
- A review of 2,520 coronary arteriographies identified 34 cases of coronary artery microfistulae.
- Most patients (28) without infarction or valve disease presented with angina-like symptoms.
- Ischemic signs were common on ECG (19/28), and positive in exercise tests/scintigraphy (2/3).
- Isolated microfistulae predominantly affected women (19/21) in their fifties, often without atheromatous disease.
Impact:
- Microfistulae are found in over 1% of adult coronary arteriographies, and 8% of those with normal coronary arteries.
- These findings suggest microfistulae represent a distinct cause of angina, particularly in women.
- Further research is needed to clarify their embryonic origin, symptom mechanisms, and relationship to "healthy coronary artery angina".