[Coronary fistulas--high prevalence in patients with heart transplantation].
Coronary artery fistulas have recently been reported to occur frequently in patients after heart transplantation due to repeated endomyocardial biopsies. To investigate if there is a relationship between development of coronary artery fistulas and the number of biopsies performed in transplanted patients, we studied the prevalence and localization of coronary artery fistulas in 168 patients after heart transplantation and in 100 control subjects. In addition to biplane ventriculography of the left ventricle, and in two-thirds of the patients the right ventricle as well, coronary angiography in multiple projections was performed at yearly intervals. The angiographic criterion for a coronary fistula was specified as visualization of a direct confluence from the arterial vascular lumen into a cardiac chamber, independent of size, which occurred prior to the venous phase, documented by opacification of the coronary sinus or great cardiac vein. The size of the fistula was assessed semi-quantitatively into one of three categories as small, barely detectable flow from a small arterial vessel with opacification of less than 10% of the involved chamber, large with direct flow from a large branch with opacification of more than one-third of the involved chamber (Figures 1a to 1c). Endomyocardial biopsies were performed weekly for the first three months after transplantation, thereafter, the interval was increased one week every three months. The prevalence of coronary fistulas in patients after heart transplantation was higher at 135/168 than in control subjects at 43/100. There were also more fistulas per patient (1.8 vs 0.67) in those transplanted than in control subjects (Figures 2a and 2b).(ABSTRACT TRUNCATED AT 250 WORDS)
Sauer
H U
HU
Klinik für Innere Medizin-Kardiologie, Deutsches Herzzentrum Berlin.
Regitz
V
V
Thierstein
T
T
Schüler
S
S
Warnecke
H
H
Hetzer
R
R
Fleck
E
E
D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D016027:Heart Transplantation / Q000502:physiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography