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Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history
M Vavuranakis1, C A Bush, H Boudoulas
1Division of Cardiology, Ohio State University, Columbus 43210, USA.
Insights
Coronary artery fistulas are rare, found in 0.1% of patients undergoing cardiac catheterization. These congenital heart anomalies, typically originating from the right coronary artery, show a good prognosis in adults with no significant hemodynamic issues.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Coronary artery fistulas (CAFs) are uncommon congenital heart defects.
- Their precise incidence, angiographic features, and long-term outcomes in adults are not well-established.
Purpose of the Study:
- To define the incidence, angiographic characteristics, and natural history of coronary artery fistulas.
- To assess the association of CAFs with hemodynamic abnormalities and other congenital heart diseases.
Main Methods:
- Retrospective analysis of 33,600 patients undergoing diagnostic cardiac catheterization.
- Identification and characterization of coronary artery fistulas, including origin and flow ratios.
- Evaluation of cardiac pressures and follow-up for complications.
Main Results:
- The incidence of CAFs was 0.1% (34 patients).
- Most fistulas originated from the right coronary artery (n=19).
- Mean pulmonary to systemic flow ratio was 1.19; most patients had normal heart pressures and no associated defects.
Conclusions:
- Coronary artery fistulas detected via diagnostic coronary angiography are rare.
- CAFs predominantly arise from the right coronary artery and are generally not associated with hemodynamic compromise or other congenital heart anomalies.
- Adults with coronary artery fistulas have a favorable prognosis.
Abstract:
The incidence, angiographic characteristics, and natural history of coronary artery fistulas in patients undergoing diagnostic cardiac catheterization have not been well defined. Of 33,600 patients who had diagnostic cardiac catheterization, 34 (0.1%) had coronary artery fistula. Nineteen fistulas originated from the right, 11 from the left anterior descending, and 4 from the circumflex coronary arteries, respectively. The mean ratio of pulmonary to systemic flow was 1.19 +/- 0.33. Only one patient with coexistent atrial septal defect had a pulmonic to systemic flow ratio > 1.5. Right and left heart pressures, with the exception of three patients in whom left ventricular end-diastolic pressures was > 12 mm Hg, were within normal limits. During a mean follow-up period of 6.3 years (range 2-14 years), there were no complications related to coronary artery fistula. It was concluded that the incidence of coronary artery fistulas detected during diagnostic coronary angiography is very low. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good.