Diagnostic and therapeutic approach of congenital solitary coronary artery fistulas in adults: Dutch case series and review of literature.
BACKGROUND
Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG).


OBJECTIVE
To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches.


METHODS
Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous 'therapeutic' embolisation (PTE group) or surgical ligation (SL group).


RESULTS
In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one.


CONCLUSIONS
Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs.
Department of Cardiology, ZGT location Hengelo, Geerdinksweg 141, 7555 DL, Hengelo, the Netherlands, samsaid@home.nl.
S A M
SA
Said
R L G
RL
Nijhuis
J W
JW
Op den Akker
G P
GP
Kimman
K G
KG
Van Houwelingen
D
D
Gerrits
A B
AB
Huisman
R H J A
RH
Slart
D M
DM
Nicastia
E M
EM
Koomen
A C
AC
Tans
N Y Y
NY
Al-Windy
U
U
Sonker
T
T
Slagboom
A C B
AC
Pronk