title: Female gender and the risk of rupture of congenital aneurysmal fistula in adults.
abstract: OBJECTIVE
  To delineate the risk factors for rupture of congenital aneurysmal fistulas in adult patients.
  
  
  METHODS
  We conducted a literature search of the Medline database using Pubmed search interface to identify reports dealing with rupture of congenital aneurysmal fistulas in an adult population. The search included the English and non-English languages between 1963 and 2005.
  
  
  RESULTS
  Fourteen adult patients (12 females) with serious and life-threatening complications secondary to aneurysmal fistulas were reported. Mean age was 62.9 years. The ethnic origins of these 14 patients were 9 Asian and 5 Caucasian. Most patients have had no other cardiac malformations. Five patients had a history of hypertension. One patient was asymptomatic. In 13 symptomatic patients, the clinical presentation was cardiac tamponade, pericardial effusion, syncope, heart failure, chest pain, dyspnea, fatigue, distal thromboembolic events with infarction, shock, and/or sudden death. Aneurysmal fistulas were identified in 10 patients; of these 6 were of the saccular type. Rupture occurred in 9 patients (8 females and 1 male). Eleven patients were treated surgically with 1 late death. Two male subjects experienced sudden unexpected cardiac death.
  
  
  CONCLUSIONS
  Rupture of congenital aneurysmal fistulas occurred more often in females. Identified risk factors for rupture, hemopericardium, tamponade, and death were among others saccular aneurysm, Asian ethnic race, origin of the aneurysmal fistulas from the left coronary artery and a history of hypertension may play a role. In this article, we present a literature review of congenital aneurysmal fistulas associated with or without rupture and a case report of a woman with unruptured aneurysmal fistula.
authors: Hospital Group Twente, Department of Cardiology, Hengelo, The Netherlands. samsaid@home.nl
authors: Salah A M
authors: SA
authors: Said
authors: Jutta M
authors: JM
authors: Schroeder-Tanka
authors: Barbara J M
authors: BJ
authors: Mulder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology / Q000628:therapy; D044466:Asian People; D002305:Cardiac Tamponade / Q000209:etiology; D003323:Coronary Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology / Q000628:therapy; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012307:Risk Factors; D012421:Rupture; D012737:Sex Factors