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Coronary artery fistulas: A 12-year single-center experience
Sofia Torres1, Mariana Vasconcelos1, Marta Tavares Silva2
1Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Coronary artery fistulas (CAFs) are rare, often incidental findings during invasive coronary angiography (ICA). Most CAFs are managed conservatively, but both percutaneous and surgical interventions are safe and effective when needed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coronary artery fistulas (CAFs) are uncommon congenital or acquired abnormalities.
- While often asymptomatic, CAFs can lead to significant clinical complications.
- Invasive coronary angiography (ICA) is a primary diagnostic tool for CAFs.
Purpose of the Study:
- To investigate the clinical characteristics of CAFs.
- To analyze angiographic features of CAFs.
- To evaluate management strategies and outcomes for CAFs in patients undergoing ICA.
Main Methods:
- Retrospective review of ICA data from May 2008 to January 2020.
- Identification and selection of patients with diagnosed CAFs.
- Collection of clinical, angiographic, therapeutic, and follow-up data from medical records.
Main Results:
- A prevalence of 0.2% for CAFs was observed (55 patients out of 32,174 ICAs).
- The left anterior descending artery (LAD) was the most common origin, with the pulmonary artery as the frequent drainage site.
- Forty patients were managed conservatively; transcatheter closure and surgical ligation were performed in 8 and 7 patients, respectively, with no periprocedural mortality.
Conclusions:
- CAFs are rare, with a prevalence of 0.2% in this cohort undergoing ICA.
- The LAD is a frequent origin, and the pulmonary artery a common drainage site for CAFs.
- Both percutaneous and surgical interventions for CAFs demonstrate safety and efficacy.
Introduction And Objectives:
Coronary artery fistulas (CAFs) are rare abnormalities, often detected incidentally during invasive coronary angiography (ICA). While most are clinically silent, they can cause significant morbidity. We aimed to investigate the clinical, angiographic and management features of CAFs in a population undergoing ICA.
Methods:
We retrospectively reviewed the data of all ICAs conducted in our department between May 2008 and January 2020 and selected those with CAFs. Clinical, angiographic, therapeutic and follow-up data were obtained from medical records.
Results:
A total of 55 patients with CAFs (35 male, median age 64 years) were identified among 32 174 ICAs. The majority (n=37) had a single fistula. CAFs arose most frequently from the left anterior descending artery (LAD), followed by the right coronary and left circumflex coronary arteries. The most frequent drainage site was the pulmonary artery. Fourteen patients had fistulas originating from both left and right coronary systems. Seven had concomitant congenital cardiovascular disorders. The majority (n=40) were incidental findings. Chest pain was the most common symptom attributable to CAFs and heart murmur the most frequent sign. Conservative management was the main approach (n=40). Eight patients underwent transcatheter closure and seven underwent surgical ligation (six of those during surgery for another heart condition), with no periprocedural mortality.
Conclusions:
In our series, the prevalence of CAFs was 0.2%. The majority originated from the LAD and the pulmonary artery was the main drainage site. In patients undergoing intervention, both percutaneous and surgical techniques were safe and effective.
