Coronary arteriovenous fistulas in the adults: natural history and management strategies

Abstract

Objective: To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies.

Methods: Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 +/- 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography

Results: All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients.

Conclusion: Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.

Figure 1

Coronary arteriovenous fistula between LAD and pulmonary artery.

Figure 2

Dilated right coronary artery and coronary arteriovenous fistula draining into the coronary sinus.