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Review
. 2024 May;26(5):373-379.
doi: 10.1007/s11886-024-02038-1. Epub 2024 Mar 11.

Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults

Jaya Kanduri  1 , Zachary Falk  2 , Harsimran S Singh  2
Affiliations
Review

Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults

Jaya Kanduri et al. Curr Cardiol Rep. 2024 May.

Abstract

Purpose of review: This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults.

Recent findings: CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.

Keywords: 3-D reconstructed models; Coronary artery fistulas; Transcatheter closure.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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    1. • Al-Hijji M, El Sabbagh A, El Hajj S, AlKhouli M, El Sabawi B, Cabalka A, et al. Coronary artery fistulas: indications, techniques, outcomes, and complications of transcatheter fistula closure. JACC: Cardiovasc Interv. 2021 July 12; 14(13):1393–406. This study highlights contemporary procedural techniques of transcatheter coronary artery fistula closure, as well as indications, outcomes, and complications of this procedure.
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