Angiographic and clinical manifestations of coronary fistulas in Chinese people: 15-year experience.
BACKGROUND
Coronary artery fistula (CAF) is an anomaly resulting in the steal phenomenon of coronary blood flow, which may cause morbidity or mortality. CAFs in Chinese patients after long-term follow-up of 15 years were retrospectively analyzed.


RESULTS
From September, 1992 to August, 2007, 152 CAFs were detected in 28,210 coronary angiograms from 125 patients. Clinical and angiographic data of all patients were analyzed retrospectively. Two types of CAFs were characterized: type I in 99 patients with 124 solitary coronary to cardiac chamber or great vessel fistula; type II: 26 patients with 28 coronary artery--left ventricular multiple microfistulas. Single-, double-, and triple-CAFs were detected in 79%, 20%, and 1% of patients, respectively. Coexistent coronary lesions were noted in 41% of patients. Fistula-related symptoms included stable angina in 55, myocardial infarction in 2, heart failure in 2, sudden death with ventricular fibrillation in 1, and syncope in 1. Twenty-four patients had coexistent congenital anomalies. Only 9 patients underwent coronary intervention or/and surgery for CAFs.


CONCLUSIONS
CAFs may cause trivial or lethal cardiac events, and may coexist with coronary lesion or congenital anomaly. Coronary to cardiac chamber or great vessel fistula and coronary-left ventricular multiple microfistulas have different morphologic and pathological phenomena.
Chiu
Chiung-Zuan
CZ
School of Medicine, Fu-Jen Catholic University, and Division of Cardiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Shyu
Kou-Gi
KG
Cheng
Jun-Jack
JJ
Lin
Shen-Chang
SC
Lee
Shih-Huang
SH
Hung
Huei-Fong
HF
Liou
Jer-Young
JY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001159:Arterio-Arterial Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D002648:Child; D002681:China; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D005080:Exercise Test; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016157:Vascular Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy