Page 17 - Journal of Structural Heart Disease Volume 4, Issue 5

Original Scientific Article
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:212-221
DOI: https://doi.org/10.12945/j.jshd.2018.043.17
Received: October 23, 2017 Accepted: November 02, 2017 Published online: October 2018
Current Interventional Management Strategies for Coronary Arteriovenous Fistulae
Awad Al-Qahtani, MD1, Ayman Zakaria, MD2, Ziyad M. Hijazi, MD, MPH, FACC, MSCAI3*
1 Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar 2 Department of Radiology, Hamad Medical Corporation, Doha, Qatar
3 Sidra Heart Center, Sidra Medicine, Doha, Qatar, Qatar
Abstract
Coronary arteriovenous fistulae are uncommon abnormal connections between one of the coronary arteries and a heart chamber or another blood ves- sel, usually pulmonary vasculature or other venous vessels. Clinically significant fistulae may lead to isch- emia of the segment of the myocardium perfused by the affected coronary artery. Therefore, closure of such fistulae is indicated. Transcatheter closure if feasible is recommended and can be achieved using different oc- clusion devices. This paper discusses the clinical classi- fication of fistulae and the interventional approach to eliminate such fistulae with some case examples. The availability of new coils and catheters render the inter- ventional approach safe and effective.
Copyright © 2018 Science International Corp.
Key Words
Coronary fistula, Coil occlusion, Congenital heart disease, Interventional therapies
Coronary artery fistula is defined as an abnormal con- nection between one of the coronary arteries and a heart chamber or another blood vessel, usually pul- monary vasculature or other venous vessels. It is esti- mated to account for 0.2-0.4% of total congenital car- diac anomalies [1]. In 1908 Maude Abbott published the first pathological account of this condition [2].
Bjork and Crafoord in 1947 performed the first suc- cessful surgical closure of a coronary fistula in a pa- tient with a preoperative diagnosis of patent ductus arteriosus [3].
In general, most coronary artery fistulae are small and do not cause any symptoms. Most are clinically undetectable and are found incidentally on echocar- diography performed for other reasons or in adults undergoing coronary angiography performed for an unrelated cause. Most fistulae resolve spontaneously without causing any complications. Only those fis- tulae that are about three times the size of a normal caliber of a coronary artery may cause symptoms or complications and require management. Symptoms may include the following:
• Dyspnea on exertion
• Angina
• Fatigue
• Palpitations
Due to steel phenomenon, large fistulae may lead to ischemia of the segment of the myocardium per- fused by the affected coronary artery. The mecha- nism is related to the diastolic pressure gradient and runoff from the coronary vasculature to a low-pres- sure receiving cavity/vessel. If the fistula is large, the intracoronary diastolic perfusion pressure progres- sively diminishes.
* Corresponding Author:
Ziyad M. Hijazi, MD, MPH, FACC, MSCAI
Cardiac Program, Department of Pediatrics
Sidra Medicine
PO Box 26999, Doha, Qatar
Tel. +974 4003 6602; Fax: +974 4404 1779; E-Mail: zhijazi@me.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISN 2326-4004
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