Coronary artery fistulae without adudible murmur in adults

Abstract

Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36-69 years). No murmur was audible in any of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary artery and the left anterior descending artery (LAD) in two, the LAD in six, and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease, and that the diagnosis is mostly incidental during routine coronary arteriography.

Demonstration of coronary-to-pulmonary fistula with MDCT and conventional angiography

“…The fistulas draining into the right ventricle are often identified in childhood because of the murmur and/or symptoms due to large fistulas resulting from high pressure differences [5]. However, the coronary-pulmonary artery fistulas are usually discovered during the routine cardiac catheterization after the development of atherosclerotic coronary artery disease, since they are mostly asymptomatic and without audible murmur [1]. Our case had no murmur related to the coronary fistula.…”

“…A great majority of the coronary-pulmonary fistulas in adults, whether congenital or acquired, are benign, in terms of their effect on coronary physiology [1]. Surgical or percutaneous closure of the fistula is recommended if it causes myocardial ischemia, large left-to-right shunts, and heart failure [2,6].…”

“…Coronary fistulas, defined as abnormal vascular communications between any coronary artery and any of the cardiac chambers or great vessels, are generally noticed incidentally on diagnostic cardiac catheterization in adult population. Although the majority of the adult cases are asymptomatic, it may also cause serious consequences including myocardial ischemia, sudden death and congestive heart failure [1,2]. Because of the complex structural anatomy and the probability of the multiple fistulas arising from different segments of the coronary arteries and coronary sinuses, conventional coronary angiography may not be sufficient.…”

Communicating bilateral coronary artery to pulmonary artery fistula with aneurysms

“…The fistulas draining into the right ventricle are often identified in childhood because of the murmur and/or symptoms due to large fistulas resulting from high pressure differences [8]. However, the CAFs are usually discovered during the routine coronary angiography after the development of atherosclerotic coronary artery disease, since they are mostly asymptomatic and without audible murmur [9].…”

Coronary-to-Pulmonary Artery Fistula and Concomitant Acute Coronary Syndrome: Two Cases

“…Our patients had no history of any disease or trauma that could have led to such fistulas. A great majority of the coronary-pulmonary fistulas in adults, whether congenital or acquired, are benign, in terms of their effect on coronary physiology [3]. Surgical or percutaneous closure of the fistula is recommended if it causes myocardial ischemia, large left-to-right shunts, and heart failure [4].…”