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[Central and peripheral coronary-pulmonary fistulae. Apropos of 4 case reports]
Insights
This study details four cases of coronary artery fistulae, abnormal connections between coronary arteries and the pulmonary artery. While some are congenital, others can be acquired, with surgical intervention rarely needed unless coronary steal occurs.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Coronary artery fistulae (CAFs) are uncommon vascular anomalies.
- Understanding their etiology and management is crucial for cardiovascular health.
Observation:
- Four cases of fistulae between coronary arteries and the pulmonary artery or its branches were analyzed.
- Proximal fistulae may arise from accessory coronary buds, while peripheral fistulae have varied congenital or acquired origins.
- Two cases involved anomalous coronary arteries stemming from the pulmonary trunk, one with severe congenital mitral insufficiency.
Findings:
- Congenital origin is suggested for proximal fistulae and some peripheral fistulae, as seen in a 54-year-old female with angina.
- Acquired origin is likely in cases related to prior cardiac surgery, such as a Blalock operation for Tetralogy of Fallot.
- The underlying mechanism for peripheral fistulae is often complex and difficult to ascertain, particularly in adults.
Implications:
- These findings contribute to the understanding of coronary artery fistula pathogenesis.
- Early diagnosis and appropriate management are essential, especially in cases of coronary steal syndrome.
- Further research may elucidate the specific mechanisms and long-term outcomes of these rare conditions.
Abstract:
The authors report four cases of fistulae between coronary arteries and the main pulmonary artery or its branches. Proximal fistulae, often considered with coronary-cardiac fistulae (between coronary arteries and cardiac cavities, usually in the right heart) probably result from accessory coronary buds originating in the truncus arteriosus, on its pulmonary part, as in anomalous coronary arteries stemming from the pulmonary trunk. Two such cases are reported, including one in a girl with severe congenital mitral insufficiency. Peripheral fistulae probably do not result from a single mechanism, and their congenital or acquired origin is often difficult to determine, especially in adults. Nevertheless, in a 54-year-old female with angina by coronary steal, without any associated pulmonary disease, the fistula is probably congenital. On the other hand, in a boy who had a Blalock operation for Tetralogy of Fallot, the fistula is probably acquired, as part of the collateral circulation which developed after pleuro-pericardial symphysis. Such fistulae usually do not require surgery except in cases of coronary artery steal, which are exceptional in children but not infrequent in adults.