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Wei P, Li Y, Zhang F, Xu Z, Xu L, Wan J, Li S, Ouyang W, Wang S, Zhang G, Tse G, Chan JSK, Fang F, Pan X. Transcatheter closure of multiple coronary artery fistulas: a coronary computed tomography angiography-based anatomic classification. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:206-217. [PMID: 39009242 DOI: 10.1016/j.rec.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas. METHODS All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups. RESULTS This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P<.001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P=.011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas. CONCLUSIONS MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.
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Affiliation(s)
- Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Yihang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Zhongying Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Liang Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Junyi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shiguo Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shouzheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Gejun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Gary Tse
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Jeffrey Shi Kai Chan
- Structural Heart Disease and Heart Failure Research Unit, Cardiovascular Analytics Group, PowerHealth Research lnstitute, Hong Kong, China
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China.
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital, Beijing, China.
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Bowles J, Martin J, Russell PL, Bailey A, Holland DJ. Coronary artery fistula following surgical myectomy for hypertrophic obstructive cardiomyopathy: a case report. Eur Heart J Case Rep 2024; 8:ytae248. [PMID: 38845810 PMCID: PMC11156195 DOI: 10.1093/ehjcr/ytae248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
Background Coronary artery fistula is a rare, but recognized complication of surgical myectomy. Although most communicate with the right heart, a large fistula into the left ventricular cavity may result in a shunt haemodynamically analogous to aortic regurgitation. Understanding the variable presentation of iatrogenic coronary fistulae and the optimal evaluation strategy is critical to obtaining a timely diagnosis and instituting treatment. Case summary We report the case of a 57-year-old renal transplant recipient admitted for evaluation of presyncope, one-year post-surgical myectomy for hypertrophic obstructive cardiomyopathy. An iatrogenic coronary artery fistula was suspected by transthoracic echocardiography, and later confirmed with both non-invasive and invasive coronary angiography. Discussion We highlight various cardiac imaging modalities that confirmed the diagnosis of coronary artery fistula and helped to determine the clinical significance. We report the tailored approach often required to determine the anatomic and haemodynamic characteristics of coronary fistulae and outline potential management strategies.
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Affiliation(s)
- James Bowles
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Joshua Martin
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Penni L Russell
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Amy Bailey
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
- School of Medicine and Dentistry, Griffith University, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, 4072 Queensland, Australia
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Ozenbas C, Sukun A. Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction. Cureus 2024; 16:e58627. [PMID: 38770477 PMCID: PMC11103546 DOI: 10.7759/cureus.58627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.
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Affiliation(s)
- Cemre Ozenbas
- Radiology, Tınaztepe University Private Buca Hospital, Izmir, TUR
| | - Abdullah Sukun
- Radiology, Başkent University Alanya Application and Research Center, Antalya, TUR
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Yan W, He Z, Luo Y, Huang W, Zhu B, Zhong Y, Wang X. Prevalence and characteristics of coronary artery fistulas among 20 259 patients undergoing invasive coronary angiography. Coron Artery Dis 2024; 35:135-142. [PMID: 38206811 DOI: 10.1097/mca.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Coronary artery fistula (CAF) is a rare coronary anomaly. This study aimed to investigate the prevalence, clinical features, and imaging characteristics of CAF among patients undergoing coronary angiography (CAG). METHOD This was a retrospective study including 20 259 consecutive patients (12 458 were male) who underwent CAG at our institution from September 2018 to March 2023. Electronic angiography records were reviewed, and a total of 86 (0.42%) CAF patients were enrolled and analyzed. RESULT Of the 86 CAF patients, 42 (49%) were male. Thus, the prevalence of CAF for males and females was 0.34% and 0.56%, respectively. Arrhythmia, left ventricular (LV) hypertrophy, LV dilation, and LV systolic dysfunction were observed in 38, 25, 10 and 5 cases, respectively. Among the 86 CAF patients, a total of 117 CAFs were detected. 61 (71%) patients had a single CAF, and the remaining 25 (29%) patients had multiple CAFs. Of the 117 CAFs, the most common origins and terminations were the left anterior descending artery (n = 50) and the pulmonary artery (n = 73), respectively. The CAF diameters were greatly varied, ranging from unmeasurable to 7.8 mm, and 22 (18%) CAFs were larger than 3 mm. CONCLUSION In the present study, the prevalence of CAF was 0.42% with a female predilection. Arrhythmia, LV remodeling and dysfunction were common. Seventy-one percent of patients had a single CAF. The left anterior descending artery and the pulmonary artery were the most common origin and termination of CAFs, respectively. Most CAFs were small, and 18% of CAFs were larger than 3 mm.
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Affiliation(s)
- Wei Yan
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Cai R, Xu J, Yan C, Wang J, Wang LI, Ku L, Zhou D, Zhu LI, He C, Zhao X, Ma X. Imaging characteristics and ECG distribution of coronary fistulas: The first large-scale study. Clin Imaging 2024; 105:110016. [PMID: 38039748 DOI: 10.1016/j.clinimag.2023.110016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The proportion of abnormal electrocardiogra (ECG) in patients with coronary artery fistula (CAF) is relatively high, but the correlation between CAF and arrhythmia is mostly reported in individual case studies. This paper analyzes the correlation between imaging features and ECG features. OBJECTIVE This paper aims to analyze the incidence and distribution characteristics of abnormal ECG in patients with CAF and further explore the difference in ECG characteristics between coronary-cameral fistula (CCF) and coronary-pulmonary artery fistula (CPAF). METHOD A total of 144,448 patients who underwent coronary computerized tomography angiography (CTA) examination from January 2016 to December 2022 were included in this study, and 284 patients with CAF (excluding coronary atherosclerosis) were selected for analysis of their ECG and image characteristics. And divided them into the CPAF (221 cases) and CCF (63 cases) groups, the differences in ECG between the two groups was compared. The changes in the ECG after the operation were analyzed. RESULTS The incidence of abnormal ECG in patients with CAF was approximately 72.9%. There were significant differences in the proportion of ECG block, myocardial ischemia and structural ECG changes between the CPAF group and CCF group (P < 0.05). CCF was more likely to cause conduction block and ischemic and structural ECG changes. A total of 53 patients with CAF underwent surgical treatment, 28 patients with improved ECG (52%). CONCLUSION CCF especially CCF patients often have abnormal ECG findings such as conduction block, myocardial ischemia, and structural changes, which can often be restored to normal through surgery.
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Affiliation(s)
- Renhui Cai
- Department of Radiology, Asia Heart Hospital, No.753 Jinghan Road, Hankou District, Wuhan 430022, PR China
| | - Juan Xu
- Department of Radiology, Asia Heart Hospital, No.753 Jinghan Road, Hankou District, Wuhan 430022, PR China
| | - Chaoqun Yan
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Jie Wang
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - L I Wang
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Leizhi Ku
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Di Zhou
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - L I Zhu
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Chunli He
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, PR China.
| | - Xiaojing Ma
- Department of Echocardiography, Asia Heart Hospital, Wuhan 430022, PR China.
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Li Y, Wei P, Xu Z, Xu L, Wan J, Zhang F, Fang F, Pan X, Zhang G. Outcomes following transcatheter closure or surgical repair of coronary-left ventricular fistula: A single-center study with 10-year experience. Hellenic J Cardiol 2023; 74:39-47. [PMID: 37321292 DOI: 10.1016/j.hjc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Coronary arteries drain into the left ventricle, known as coronary-left ventricular fistula (CLVF), an extremely rare anomalous coronary artery disease. Little is known about the outcomes following transcatheter closure (TC) or surgical closure (SC) of CLVF. METHOD This was a single-center retrospective study including 42 consecutive patients who underwent either the TC or SC procedure from January 2011 to December 2021. The baseline and anatomic characteristics of the fistulas, procedural outcomes, and late outcomes were summarized and analyzed. RESULTS The mean age was 31.6 ± 16.2 years, with 28 male patients (66.7%). Fifteen patients underwent SC group and the remaining received TC group. There were no differences in age, comorbidities, clinical presentations, and anatomic characteristics between the 2 groups. The procedural success rate was similar (93.3% vs. 85.2%, P = 0.639) without operative and in-hospital mortality in both groups. Notably, patients who underwent TC had a significantly shorter postoperative in-hospital length of stay (2.11 ± 1.49 vs. 7.73 ± 2.37 days, P<0.001). The median follow-up time was 4.6 years (2.5-5.7 years, TC group) and 3.98 years (0.42-7.15 years, SC group), respectively. No difference was observed in the incidence of recanalization of the fistula (7.4% vs. 6.7%, P = 1) and myocardial infarction (0% vs. 0%). Cerebral infarction due to discontinuation of anticoagulants happened to two patients in the TC group. Importantly, thrombotic occlusion of the fistulous tract with patent parent coronary artery was found in 7 patients of the TC group. CONCLUSION Both transcatheter and SC are safe and effective for patients with CLVF. Thrombotic occlusion is a noteworthy late complication, and its presence indicates the use of anticoagulants lifelong.
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Affiliation(s)
- Yihang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhongying Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liang Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junyi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Gejun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Scalera S, Clemente A, Pizzuto A, Gasparotti E, Fanni BM, Vignali E, Capellini K, Celi S, Santoro G. 3D Printed Model-Guided Neonatal Transcatheter Closure of Left Main Coronary Artery-to-Right Ventricle Fistula. JACC Case Rep 2023; 16:101869. [PMID: 37396316 PMCID: PMC10313481 DOI: 10.1016/j.jaccas.2023.101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 07/04/2023]
Abstract
We report on a 2-week-old infant with huge left main coronary artery-to-right ventricular outflow tract fistula causing myocardial ischemia due to global coronary steal who was successfully submitted to percutaneous closure guided by a 3-dimensional-printed model using a duct-occluder vascular plug. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Silvia Scalera
- Pediatric Cardiology and GUCH Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Alberto Clemente
- Radiodiagnostic Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Emanuele Gasparotti
- BioCardioLab-Bioengineering Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Benigno Marco Fanni
- BioCardioLab-Bioengineering Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Emanuele Vignali
- BioCardioLab-Bioengineering Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Katia Capellini
- BioCardioLab-Bioengineering Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Simona Celi
- BioCardioLab-Bioengineering Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, G. Pasquinucci Heart Hospital, National Research Council–G. Monasterio Tuscany Foundation, Massa, Italy
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