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[Coronary arteriovenous fistula. Study of 14 cases]
Insights
Coronary arteriovenous fistulae often present with symptoms mimicking other heart conditions, requiring angiography for diagnosis. Early surgical ligation is recommended despite surgical risks, as complications like heart failure and pulmonary hypertension are frequent.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Coronary arteriovenous fistulae (CAVF) are rare congenital or acquired abnormalities.
- Diagnosis can be challenging due to non-specific clinical presentations.
Purpose of the Study:
- To analyze the characteristics, clinical presentation, and outcomes of coronary arteriovenous fistulae.
- To evaluate the effectiveness and risks of surgical intervention for CAVF.
Main Methods:
- Retrospective analysis of 14 patients with CAVF.
- Review of clinical, radiological, and electrocardiographic findings.
- Diagnostic confirmation via angiography; echocardiography also utilized.
Main Results:
- Most fistulae originated from the right coronary artery and drained into the right ventricle.
- High rates of complications including heart failure (42.9%), pulmonary hypertension (54.5%), and infective endocarditis (14.3%).
- Mortality rate was 28.6%; perioperative myocardial infarction occurred in 2 of 3 operated patients.
Conclusions:
- CAVF diagnosis relies heavily on angiography, though echocardiography is useful.
- Early elective surgical ligation is the preferred treatment, necessitating improved surgical techniques to mitigate risks like myocardial infarction.
Abstract:
Fourteen cases of coronary arteriovenous fistulae observed at the Instituto Nacional de Cardiología Ignacio Chávez were analyzed. The fistula originated from the right coronary artery in 57.1% of the cases, from the left coronary artery in 35.7% and from both coronary arteries in 7.2%. Drainage occurred into the right ventricle in 71.4% of the cases, into the right atrium in 7.2% and into the main pulmonary artery in 21.4%. The physical, roentgenological and electrocardiographic findings are undistinguishable from those usually obtained in malformations with a shunt between the aorta and the right heart or the pulmonary artery. Definite diagnosis is made at angiography. 2D and Doppler echocardiography may also be very useful. Natural history depends on the age of the patient, the size of the arteriovenous shunt, the presence of pulmonary hypertension and the development of complications. Even though malformations with small shunts may be well tolerated, serious complications are frequent and, thus, 14.3% of the patients developed infective endocarditis, 42.9% were in heart failure, 14.3% complained of angina pectoris and 54.5% had pulmonary hypertension. Mortality in this series was 28.6%. Early elective ligation seems to be the optimal treatment of coronary arteriovenous fistulae. The surgical procedure, however, is not devoid of risk. Thus, two of the three patients in this series who were operated upon after 1967 developed perioperative myocardial infarctions. Improvement in surgical technique should prevent this complication.