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Coronary Artery Fistula : Should We Close?

Author : D.G. Arilaksono, N. Haryono, A.S. Soerianat, D. Firman, A.A. Alkatiri,
Upload Date : 19-04-2018

Background: Coronary fistulas are congenital or acquired anomalous shunts from a coronary artery to any cardiac chamber or great vessel. Most of this anomaly is asymptomatics and identified incidentally. One of the management is to close the fistula either transcatheter or surgical. The aim of this presentation is to discuss two cases of symptomatic right coronary artery to pulmonary artery fistula and discuss about their clinical feature, diagnostic and management strategy

Case Illustration: The first patient, a 64 years old female complaining chest pain during activity. Coronary angiography revealed non significant coronary artery disease with right coronary artery to pulmonary artery fistula.  The second patient, a 51 years old male with typical chest pain and history of myocardial infarction. Coronary angiography showed multiple significant coronary artery stenosis and right coronary artery to pulmonary artery fistula. Transcatheter coronary fistula closure were performed on both patient with good results.

Discussion: Most of the coronary artery fistula drain to right side of the heart (pulmonary circulation). Therefore a left to right shunt may be found and causing coronary steal phenomenon. Since the majority of coronary artery fistula are asymptomatic, they were treated conservatively. Indications to perform closure are significant left-to-right shunt, ventricular volume overload, signs ans symptoms of myocardial ischaemia, left ventricular dysfunction, congestive cardiac failure and for prevention of endocarditis or endarteritis. There are also some factors that need to be considered when planning the management of coronary artery fistula, include the size of the fistula, presence of symptoms or complications likely related to the fistula, the age of the patient, the relative size of the fistula, the anatomy of the fistula, and whether the patient has other indications to be undergoing an invasive procedure.

KEYWORDS : Coronary artery fistula, Steal phenomenon, Transcatheter fistula closure

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