Coronary Artery Fistulas: Case Series and Literature Review

Abstract

Congenital coronary artery fistulas are rare anomalies. As coronary angiography and multidetector computed tomography have become more accessible, they have been increasingly used in the investigation of chest pain and heart failure. Coronary artery fistulas are often an incidental finding, which raises the question of how patients with this condition should be managed. Intervention with either transcatheter closure or surgical closure is often technically possible. Many patients are asymptomatic early after closure. However, follow-up studies have shown post-closure sequelae, such as residual leakage, thrombosis with or without myocardial infarction, and coronary stenosis. Therefore, there has been a shift from intervention towards watchful waiting in asymptomatic patients. In this article, we review the published literature on the natural history and treatment outcomes in individuals with coronary artery fistulas. We present case reports from our clinic and discuss the management of incidental findings of coronary artery fistulas.

Coronary Artery Fistulas

“…Karazisi et al [1], in this issue of Cardiology, present 7 cases with a coronary artery fistula (CAF) who were treated between 1995 and 2015 at the Adult Congenital Heart Unit and/or Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden. In the same paper, the authors also review the literature on the topic [1].…”

“…In the same paper, the authors also review the literature on the topic [1]. The paper provides sound information regarding a rare, but occasionally challenging, disease for the practicing cardiologist.…”

“…For instance, CAF formation may occur after a myocardial infarction or may be seen in Takayasu arteritis or polymyositis. Further, a CAF may occur after a cardiac procedure including coronary bypass or valve replacement surgery, lead placement for pacing or defibrillation, myocardial biopsies in patients with cardiac transplantation, or other cardiac procedures [1,2,3]. …”

“…CAFs more often are isolated anomalies, but occasionally they may be associated with other congenital heart diseases [1,2]. Depending on the size and the amount of blood flowing through the fistula, a continuous or diastolic murmur may be heard at the site of fistula emptying.…”

“…The patient may present with dyspnea, fatigue, cardiac arrhythmias, or chest pain; infective endocarditis also has been reported. Chest pain is secondary to myocardial ischemia due to the steal phenomenon that leads to a decreased myocardial blood flow distal to the fistula [1,2,4,5,6,7]. …”