Said S A M, van der Werf T
Departments of Cardiology, Hospital ZGT, Location Geerdinksweg 141, 7555 DL Hengelo, The Netherlands.
Int J Cardiol. 2006 Jan 26;106(3):323-32. doi: 10.1016/j.ijcard.2005.01.047.
Congenital coronary artery fistulas are frequently identified in adult and pediatric populations and they have been associated with various clinical and morphological features. The purpose of this study was to define the clinical and coronary angiographic morphological characteristics of adult patients with congenital solitary CAFs in the Dutch Registry.
Fifty-one patients with angiographically documented CAFs were reviewed for clinical evaluation, used non-invasive and invasive diagnostic tools and treatment modalities. Unilateral CAFs were predominant (80%) and 84% of the patients were symptomatic. The most common presenting symptom was angina pectoris (57%). Angina pectoris was present in a quarter of the patients in the absence of coronary artery disease (CAD). Significant CAD was present in 49% of the patients. Twenty-nine percent of the CAFs showed aneurysmal formation, underlying their potential hazard of rupture. Myocardial infarction occurred in 18% of the patients. In 27% of CAFs multiplicity of the origin was found and nearly all fistulas were tortuous (97%). Treatment modalities were conservative medical in 70%, percutaneous transluminal embolisation in 5% and surgical ligation in 25% of the cases. Multiple micro-fistulas from the coronary arteries to the left ventricle were excluded from the study.
In this national survey series, congenital solitary CAFs can be presented with typical angina pectoris in the absence of obstructive CAD. Fistula-related coronary artery was infrequently involved in the development of ipsilateral myocardial infarction. Tortuousity and multiplicity of the CAFs may determine, for the individual patient, the choice of the currently available treatment modalities.
先天性冠状动脉瘘在成人和儿童群体中经常被发现，并且与各种临床和形态学特征相关。本研究的目的是在荷兰注册中心确定成年先天性孤立性冠状动脉瘘患者的临床和冠状动脉造影形态学特征。
对51例经血管造影证实患有冠状动脉瘘的患者进行临床评估，使用非侵入性和侵入性诊断工具及治疗方式。单侧冠状动脉瘘占主导（80%），84%的患者有症状。最常见的症状是心绞痛（57%）。四分之一无冠状动脉疾病（CAD）的患者有心绞痛。49%的患者存在显著的CAD。29%的冠状动脉瘘有动脉瘤形成，提示其潜在的破裂风险。18%的患者发生心肌梗死。27%的冠状动脉瘘发现起源多样，几乎所有瘘管都有迂曲（97%）。70%的病例采用保守药物治疗，5%采用经皮腔内栓塞治疗，25%采用手术结扎治疗。本研究排除了从冠状动脉到左心室的多发性微瘘。
在这个全国性调查系列中，先天性孤立性冠状动脉瘘在无阻塞性CAD时可表现为典型心绞痛。与瘘相关的冠状动脉很少参与同侧心肌梗死的发生。冠状动脉瘘的迂曲和多样可能决定个体患者目前可用治疗方式的选择。
