[Left coronaro-ventricular microfistulas. Apropos of 25 cases]

Area of Science:

• Cardiology
• Vascular Radiology
• Medical Imaging

Background:

• Left coronaroventricular microfistulae are rare vascular anomalies.
• Their prevalence and clinical significance are not fully understood.
• These microfistulae may be implicated in cases of angina with angiographically normal coronary arteries.

Purpose of the Study:

• To analyze the characteristics and clinical presentation of left coronaroventricular microfistulae.
• To investigate the association between microfistulae and coronary artery disease.
• To explore the diagnostic utility of microfistulae detection in patients with angina.

Main Methods:

• Retrospective analysis of 25 patients with left coronaroventricular microfistulae.
• Review of international literature on similar cases.
• Correlation of microfistulae presence with coronary lesions, vascular disease, and myocardial insufficiency.

Main Results:

• Microfistulae represented 1.33% of adult coronarographies in the study series.
• Isolated microfistulae predominantly affected women around 50 years old (16 cases).
• Patients with isolated microfistulae experienced typical angina without infarction, but with significant disability.

Conclusions:

• Left coronaroventricular microfistulae may be underestimated and present specific imaging findings.
• Myocardial ischemia in these patients could be due to a coronary steal phenomenon.
• Detecting microfistulae, combined with metabolic studies, can aid in classifying angina with normal coronary arteries.