Treatment approaches to coronary artery fıstulae: A sıngle center trıal

BackgroundA coronary artery fistula (CAF) is a sizable communication between a coronary artery, bypassing the myocardial capillary bed and entering either a chamber of the heart or any segment of the systemic or pulmonary circulation. It accounts for 0.27–0.40% of all cardiac defects.Patients and methodsThe study included 6 CAF patients hospitalized between January 2010 and June 2016. The mean patient age was 52.6. The sites of origin of the fistulae were from the left coronary artery in 4, from the right coronary artery in 1 and from right and left coronary arteries in 1 patient/patients. In all patients the site of termination was the pulmonary artery. The fistulae were closed surgically in 4 patients who also had accompanying cardiac pathology (3 patients with coronary artery disease and 1 patient with mitral stenosis) and in 2 patients without additonal coronary pathology with coil embolization performed in the angiography unit. In the surgically treated group, with cardiopulmonary bypass the fistula opening was closed through pulmonary arteriotomy in 2 patients and fistula was ligated epicardially in 2 patients. Moreover, in the surgical group of 4 patients, coronary artery bypass grafting was performed on 3 patients with coronary artery disease, and mitral valve replacement on 1 patient with mitral stenosis.ResultsAll patients had no pathological symptoms and findings in the follow-up controls one and three months after the surgery.ConclusionWe suggest that CAF in patients with additional cardiac pathology should be treated surgically and others by performing coil embolization