Abstract
ObjectiveThe aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes.MethodsTwenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted.ResultsA total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation.ConclusionThe decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.
Highlights
Coronary arteriovenous fistulas (CAVFs) are uncommon in the adult population, and can be defined as a condition where the coronary blood flow is usually shunted into a cardiac chamber, great vessels, or other structures, bypassing the myocardial capillary network resulting in a coronary steal phenomenon with myocardial ischemia, causing morbidity and mortality[1,2]
A total of 25 CAVFs were detected in the entire cohort; CAVFs originated mainly from left anterior descending coronary artery (LAD) (n=9, 42.8%), the rest taking origin from diagonal artery (n=3, 14.2%), circumflex artery (n=2, 9.5%), right coronary artery (RCA) (n=2, 9.5%), and left main stem (n=1, 4.7)
Four (19.4%) patients had bilateral fistulas originating from both LAD and RCA (Figure 1)
Summary
Coronary arteriovenous fistulas (CAVFs) are uncommon in the adult population, and can be defined as a condition where the coronary blood flow is usually shunted into a cardiac chamber, great vessels, or other structures, bypassing the myocardial capillary network resulting in a coronary steal phenomenon with myocardial ischemia, causing morbidity and mortality[1,2]. CAVFs are present in 0.002% of the general population and they are detected in 0.3-0.8% of the patients undergoing diagnostic cardiac catheterization[5,6]. Some previous studies reported frequent origin of CAVFs from the right coronary artery (RCA), some authors mentioned that CAVFs. This study was carried out at the Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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