Coronary artery fistula: review of 54 cases from single center experience.
BACKGROUND
Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail.


METHODS
We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study.


RESULTS
A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%.


CONCLUSIONS
Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed.
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Yigit
Y
Canga
Kazim Serhan
KS
Ozcan
Ayse
A
Emre
Seref
S
Kul
Tolga Sinan
TS
Guvenc
Gunduz
G
Durmus
Veli
V
Kirbas
Erkan
E
Ilhan
Mehmet Baran
MB
Karatas
Dilaver
D
Oz
Sait
S
Terzi
Kemal
K
Yesilcimen
D000015:Abnormalities, Multiple; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000209:etiology; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014421:Turkey; D016157:Vascular Fistula / Q000150:complications / Q000175:diagnosis / Q000628:therapy