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Coronary arterial fistulas.

Qureshi SA - Orphanet J Rare Dis (2006)

Bottom Line: They do not usually cause symptoms or complications in the first two decades, especially when small.Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices.With the catheter technique, the results are excellent with infrequent complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Evelina Children's Hospital, Guy's & St Thomas's Hospital Foundation Trust, London, UK. Shakeel.Qureshi@gstt.nhs.uk

ABSTRACT
A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications.

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1a shows a dilated fistula between the proximal right coronary artery and right atrium. Such a fistula is suitable for an occlusion device such as the Amplatzer duct occluder (Figure 1b).
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Figure 1: 1a shows a dilated fistula between the proximal right coronary artery and right atrium. Such a fistula is suitable for an occlusion device such as the Amplatzer duct occluder (Figure 1b).

Mentions: The feeding artery of the fistula may drain from a main coronary artery or one of its branches and is usually a dilated and tortuous artery terminating in one of the cardiac chambers or a vessel. The more proximal the feeding artery originates from the main coronary artery, the more dilated it tends to be. If the fistula drains to the right atrium with a proximally arising feeding artery, it tends to be considerably dilated but less tortuous (Figure 1a, b and Figure 2a, b). If there is a more distal origin of the feeding artery, and in particular when the fistulas originate from the left coronary artery and drain to the left ventricle, they may be very tortuous, presenting a challenge for catheter closure (Figure 3a, b). However, in the less frequently encountered right coronary artery to coronary sinus drainage, the fistula vessel may be large and very tortuous. It is important to note that there may be multiple feeding arteries to a single coronary arterial fistula drainage point or there may be multiple drainage sites [2]. The fistulas originate from the right coronary artery in about 52% of cases, the left anterior descending coronary artery being the next most frequently involved in approximately 30% of cases and the circumflex coronary artery in about 18% of cases [4]. Over 90% of the fistulas from either coronary artery drain to the right side of the heart and the remainder drain to the left side of the heart [5]. In the right heart, drainage occurs most frequently to the right ventricle (in about 40%), followed by the right atrium, coronary sinus, and pulmonary trunk. Multiple fistulas between the three major coronary arteries and the left ventricle have also been reported [6]. In adults, occasionally fistulas may be encountered which originate from both the coronary arteries and drain into the pulmonary trunk. These fistulas may cause angina and require closure (Figure 4a, b).


Coronary arterial fistulas.

Qureshi SA - Orphanet J Rare Dis (2006)

1a shows a dilated fistula between the proximal right coronary artery and right atrium. Such a fistula is suitable for an occlusion device such as the Amplatzer duct occluder (Figure 1b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1764722&req=5

Figure 1: 1a shows a dilated fistula between the proximal right coronary artery and right atrium. Such a fistula is suitable for an occlusion device such as the Amplatzer duct occluder (Figure 1b).
Mentions: The feeding artery of the fistula may drain from a main coronary artery or one of its branches and is usually a dilated and tortuous artery terminating in one of the cardiac chambers or a vessel. The more proximal the feeding artery originates from the main coronary artery, the more dilated it tends to be. If the fistula drains to the right atrium with a proximally arising feeding artery, it tends to be considerably dilated but less tortuous (Figure 1a, b and Figure 2a, b). If there is a more distal origin of the feeding artery, and in particular when the fistulas originate from the left coronary artery and drain to the left ventricle, they may be very tortuous, presenting a challenge for catheter closure (Figure 3a, b). However, in the less frequently encountered right coronary artery to coronary sinus drainage, the fistula vessel may be large and very tortuous. It is important to note that there may be multiple feeding arteries to a single coronary arterial fistula drainage point or there may be multiple drainage sites [2]. The fistulas originate from the right coronary artery in about 52% of cases, the left anterior descending coronary artery being the next most frequently involved in approximately 30% of cases and the circumflex coronary artery in about 18% of cases [4]. Over 90% of the fistulas from either coronary artery drain to the right side of the heart and the remainder drain to the left side of the heart [5]. In the right heart, drainage occurs most frequently to the right ventricle (in about 40%), followed by the right atrium, coronary sinus, and pulmonary trunk. Multiple fistulas between the three major coronary arteries and the left ventricle have also been reported [6]. In adults, occasionally fistulas may be encountered which originate from both the coronary arteries and drain into the pulmonary trunk. These fistulas may cause angina and require closure (Figure 4a, b).

Bottom Line: They do not usually cause symptoms or complications in the first two decades, especially when small.Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices.With the catheter technique, the results are excellent with infrequent complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Evelina Children's Hospital, Guy's & St Thomas's Hospital Foundation Trust, London, UK. Shakeel.Qureshi@gstt.nhs.uk

ABSTRACT
A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications.

Show MeSH
Related in: MedlinePlus