[Coronary fistula --clinical and angiographic review].

OBJECTIVE

To evaluate clinical and angiography date of patients (pts) in whom coronary arteriovenous fistula were detected.

STUDY DESIGN

Retrospective study of diagnostic coronary angiographies done between 1988 and 1993 in whom coronary arteriovenous fistula were detected.

SETTING

Patients submitted to cardiac catheterisation in the Cardiology Department of Santa Marta Hospital in whom coronary arteriovenous were detected.

PATIENTS

Fourteen pts, 10 male and 4 female, with a mean age of 49 years (21-72).

INTERVENTIONS

A retrospective analysis of clinical data and coronary artery anomalies was done. Whenever available, the Pulmonary Artery and the shunt (calculated through oximetries) were evaluated.

RESULTS

The following pathologies were associated: rheumatic valve heart disease (3 pts), Tetralogy of Fallot (2 pts), atrial septal defect--ostium primum (1 pt), dilated cardiomyopathy (1 pt), hypertrophic cardiomyopathy (1 pt), atherosclerotic coronary artery disease (2 pts). Four pts were in atrial fibrillation and the others in sinus rhythm. Four pts had normal ECG. In 6 pts there was cardiomegaly on the chest X-rays. The fistula was single in 11 pts, double in one and multiple in 2 other pts. The fistula originated from the right coronary artery in 6 pts, the left anterior descending coronary artery in 5 pts, the circumflex coronary artery in 3 pts and the left main coronary artery in one pt. Eight drained to the pulmonary artery (or its branches), 2 to the coronary sinus, one directly to the right atrium, one to the right ventricle and one to the left atrium. In only 2 pts the fistula was closed. In 6 pts the associated anomalies were corrected. With a mean follow up of 24 months (1-72), 8 pts are asymptomatic, 4 complain of slight heart failure, 3 of angina pectoris and the pt with dilated cardiomyopathy died 1 year after being studied.

CONCLUSION

A male predominance was found. Most fistulae were single. The artery mostly involved was the right coronary artery and the fistula drained more often to the pulmonary artery or its branches.