Coronary-cameral fistulas in adults: Acquired types (second of two parts)

Abstract

Acquired coronary artery fistulas (CCFs) are infrequently detected during conventional coronary angiography. To delineate the characteristics of congenital (first part) and acquired (second part) CCFs in adults, a PubMed search was conducted for papers dealing with congenital or acquired CCFs. None of the publications describing patients with coronary-vascular fistulas were included. Papers dealing with pediatric subjects were excluded. From the world literature, a total of 243 adult patients were selected who had congenital (n = 159/243, 65%) and acquired (n = 84/243, 35%) CCFs. Among the acquired types (n = 72, 85.7%) were traumatic (iatrogenic (n = 65/72, 90%), accidental (n = 7/72, 10%) and (n = 12, 14.3%) spontaneously developing in relation to severe coronary atherosclerosis or myocardial infarction. A high incidence of spontaneous resolution of iatrogenic CCFs resulting from endomyocardial biopsy or following post-septal myectomy was reported. Spontaneous CCFs associated with myocardial ischemia or infarction resolved completely in 8% of the subjects. Early surgical intervention was the treatment of choice in acquired traumatic accidental CCFs. The congenital types are addressed in a previous issue of this journal (first part). In this review (second of two parts, part II), we describe the acquired coronary-cameral fistulas.

Keywords: Accidental coronary-cameral fistulas; Acquired coronary-cameral fistulas; Coronary angiography, Spontaneous resolution; Iatrogenic coronary-cameral fistulas; Spontaneous coronary-cameral fistulas; Surgical treatment.

Figure 1

Flow diagram of literature search of coronary cameral fistulas in adult population.

Figure 2

Schematic representation of review subjects with congenital and acquired coronary-cameral fistulas. ICD: Implantable cardioverter-defibrillator; PCI: Percutaneous coronary intervention; RF: Radiofrequency.

Figure 3

Schematic examples of some of the conditions, procedures and attributes involved in the development of (A) acquired traumatic iatrogenic and (B) acquired traumatic accidental coronary-cameral fistulas. A: 1: Surgical scalpel; 2: Radiofrequency cardio-ablation (arrow heads), and transseptal puncture (arrow); 3: ICD lead (arrows); and 4: Pacing leads; B: 1 Soccer game; 2 Boxing; 3: Shrapnel; and 4: Knife. CS: Coronary sinus; ICD: Internal cardioverter defibrillator; IVC: Inferior vena cava; LA: Left atrium; LIPV: Left inferior pulmonary vein; LSPV: Left superior pulmonary vein; RA: Right atrium; RAA: Right atrial appendage; RIPV: Right inferior pulmonary vein; RSPV: Right superior pulmonary vein; RV: Right ventricular; SVC: Superior vena cava.