Adult Coronary Artery Fistula - A Retrospective Analysis of 14 Cases

Background and Purpose: Coronary artery fistula is a rare congenital anomaly. The purpose of this retrospective study was to analyze the prevalence, angiographic characteristics, and the natural history of coronary artery fistulas in Southern Taiwan adult patients undergoing diagnostic cardiac catheterization and to compare with results from Western countries. Methods and Results: Of 4300 patients who had diagnostic cardiac catheterization, 14 (0.3%) had coronary artery fistulas, with totally 20 fistulas in angiograms, with males predominant (12/14, 85.7%). Only one patient was found to have a continuous murmur. Most of the fistulas were single (9/20, 64.2%). Ten fistulas (50%) originated from the left anterior descending artery, 5 from the right, 4 from the circumflex and 1 from the left main coronary artery, respectively. The majority of the fistulas (15/20, 75%) drained into the pulmonary artery. There were one-third of patients (5/14, 35.7%) with occlusive coronary artery disease but with less other congenital anomalies. The mean ratio of pulmonary to systemic flow was 1.25±0.15. Neither significant oxygen step-up nor combination of congenital heart abnormalities was noted. During a mean follow-up period of 6.3 years (range from 6 months to 10 years), there were no complications related to coronary artery fistula. Conclusions: In conclusion, the prevalence rate of coronary artery fistulas detected during routine diagnostic coronary angiography is very low in Southern Taiwan. Most of our patients are male in sex. The coronary artery fistulas originate predominantly from the left coronary artery and drain into pulmonary artery. In our series, the fistulas were not associated with hemodynamic abnormalities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good.