Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes

Abstract

ObjectiveThe aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes.MethodsTwenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted.ResultsA total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation.ConclusionThe decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.

The clinical characteristics of coronary artery fistula anomalies in children and adults: A 24‐year experience

“…Similarly, the majority of patients presented with a murmur on examination (continuous murmur in nearly half), which was more common in the younger cohort. Lo et al and Albeyoglu et al both reported similar proportions of patients presenting with a murmur, 77.8% and 85.7%, respectively . Half of their patients presented with electrocardiographic abnormalities and 64% with cardiac enlargement or increased pulmonary vascular on chest X‐ray, similar to prior reports and the present series .…”

“…In the reports by Song et al and Lo et al of pediatric‐aged patients, 84% and 74% patients had no symptoms, respectively . On the other hand, in the reports by Albeyoglu et al and Abdelmoneim et al of 21 adult patients, the majority were symptomatic . This is likely explained by the inclusion of older patients.…”

“…[13][14][15] However, other studies have suggested that the majority of fistulas originate from the left main coronary artery or its branches and terminate in the right atrium, right ventricle or pulmonary trunk. 10,16 These differences may be related to a smaller sample size or differences between varying ethnic populations.…”

A giant sinus node artery fistulizing to superior vena cava presenting with steal phenomenon: An unusual case report

“…Coronary fistulas mainly originate from the right coronary artery, less frequently from the left coronary artery, or both. They were found to originate from the right coronary artery with a frequency of 19.7% in the Albeyoglu et al, [6] 50% in the Levin et al, [7] 65% in Lowe, [8] and 51% in the Wilde and Watt [9] series. Drainage occurs to the low-pressure heart chambers.…”

“…Ischemia occurs, when the pulse pressure providing the coronary f low is lowered by steal phenomenon. [6] One of the potential complications is premature atherosclerosis, resulting in an intimal damage caused by high-volume blood flow. [3] Our case had primarly angina symptoms and tachycardia episodes.…”