Skip to main content
Erschienen in: Herz 1/2015

01.03.2015 | Original article

Prevalence of coronary artery fistulae after cardiac surgery

Comparison between coronary artery bypass grafting, valve surgery, and orthotopic heart transplantation

verfasst von: A. Young, R. Cheng, J. Wei, F. Esmailian, J. Currier, B. Azarbal, MD

Erschienen in: Herz | Sonderheft 1/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Coronary artery fistulae (CAF) are anomalous connections from a coronary artery to a recipient pulmonary vessel or cardiac chamber, and are reported in 0.2 % of the general population. The prevalence of CAF in the modern orthotopic heart transplant (OHT) population has been demonstrated to be significantly higher. The mechanism is unknown but one proposal is endothelial and vascular growth factor activation from injury. We hypothesize an incremental increase in CAF prevalence with the complexity of surgery, such that patients who have undergone OHT surgery would have an increased prevalence of CAF, as compared with patients who have undergone coronary artery bypass (CABG) surgery with valve surgery and as compared with patients who have undergone CABG surgery only.

Patients and methods

Consecutive angiograms of 481 patients after CABG surgery and 432 patients after OHT were reviewed. Patients who had previous valve surgery in addition to CABG were identified. Presence of CAF was determined. The chi-squared test was used for statistical analysis.

Results

In all, 436 patients had CABG only (group A), 45 patients had CABG with valve surgery (group B), and 432 patients had OHT (group C). The mean age of patients at the time of surgery for group A, B, and C was 59.0, 66.1, and 55.3 years, respectively. The percentage of male patients was 78.4, 77.8, and 77.1 %, respectively. We found 10 patients (2.3 %) with CAF in group A compared with 4 patients (8.9 %) in group B, and 88 patients (20.4 %) in group C, which was statistically significant (p < 0.001). All CAF were small, were not associated with hemodynamic compromise or significant adverse events, and were managed conservatively.

Conclusion

There is an increased prevalence of CAF formation both after CABG and OHT compared with the general population. The higher prevalence of CAF in patients who additionally underwent valve surgery or who underwent OHT may be attributed to differences in surgical complexity. The increased prevalence of CAF formation after OHT compared with CABG should be further investigated.
Literatur
1.
Zurück zum Zitat Baltaxe HA, Wixson D (1977) The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology 122(1):47–52CrossRefPubMed Baltaxe HA, Wixson D (1977) The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology 122(1):47–52CrossRefPubMed
2.
Zurück zum Zitat Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 21(1):28–40CrossRefPubMed Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 21(1):28–40CrossRefPubMed
3.
Zurück zum Zitat Said SA, Gamal MI el, Werf T van der (1997) Coronary arteriovenous fistulas: collective review and management of six new cases—changing etiology, presentation, and treatment strategy. Clin Cardiol 20(9):748–752CrossRefPubMed Said SA, Gamal MI el, Werf T van der (1997) Coronary arteriovenous fistulas: collective review and management of six new cases—changing etiology, presentation, and treatment strategy. Clin Cardiol 20(9):748–752CrossRefPubMed
4.
Zurück zum Zitat Lee RT, Mudge GH, Colucci WS (1988) Coronary artery fistula after mitral valve surgery. Am Heart J 115(5):1128–1130CrossRefPubMed Lee RT, Mudge GH, Colucci WS (1988) Coronary artery fistula after mitral valve surgery. Am Heart J 115(5):1128–1130CrossRefPubMed
5.
Zurück zum Zitat Nguyen-Do P, Bannon P, Leung DY (2004) Coronary artery to the left atrial fistula after resection of atrial appendages. Ann Thorac Surg 78(2):e26–e27CrossRefPubMed Nguyen-Do P, Bannon P, Leung DY (2004) Coronary artery to the left atrial fistula after resection of atrial appendages. Ann Thorac Surg 78(2):e26–e27CrossRefPubMed
6.
Zurück zum Zitat Allen KY, Goldstein BH, Pahl E et al (2012) Non-cameral coronary artery fistulae after pediatric cardiac transplantation: a multicenter study. J Heart Lung Transplant 31(7):744–749CrossRefPubMed Allen KY, Goldstein BH, Pahl E et al (2012) Non-cameral coronary artery fistulae after pediatric cardiac transplantation: a multicenter study. J Heart Lung Transplant 31(7):744–749CrossRefPubMed
7.
Zurück zum Zitat Wei J, Azarbal B, Singh S et al (2013) Frequency of coronary artery fistulae is increased after orthotopic heart transplantation. J Heart Lung Transplant 32(7):744–746CrossRefPubMed Wei J, Azarbal B, Singh S et al (2013) Frequency of coronary artery fistulae is increased after orthotopic heart transplantation. J Heart Lung Transplant 32(7):744–746CrossRefPubMed
8.
9.
Zurück zum Zitat Said SA (2011) Current characteristics of congenital coronary artery fistulas in adults: a decade of global experience. World J Cardiol 3(8):267–277CrossRefPubMedCentralPubMed Said SA (2011) Current characteristics of congenital coronary artery fistulas in adults: a decade of global experience. World J Cardiol 3(8):267–277CrossRefPubMedCentralPubMed
10.
Zurück zum Zitat Gildein HP, Kleinert S, Layangool T, Wilkinson JL (1995) Acquired coronary artery fistula in children after ventricular septal myectomy of the right or left ventricular outflow tract. Am Heart J 130(5):1124–1126CrossRefPubMed Gildein HP, Kleinert S, Layangool T, Wilkinson JL (1995) Acquired coronary artery fistula in children after ventricular septal myectomy of the right or left ventricular outflow tract. Am Heart J 130(5):1124–1126CrossRefPubMed
11.
Zurück zum Zitat Kobashigawa JA, Patel J, Furukawa H et al (2006) Five-year results of a randomized, single-center study of tacrolimus vs microemulsion cyclosporine in heart transplant patients. J Heart Lung Transplant 25(4):434–439CrossRefPubMed Kobashigawa JA, Patel J, Furukawa H et al (2006) Five-year results of a randomized, single-center study of tacrolimus vs microemulsion cyclosporine in heart transplant patients. J Heart Lung Transplant 25(4):434–439CrossRefPubMed
12.
Zurück zum Zitat Jebara VA, Sarkis A, Acar C et al (1991) Coronary artery-left ventricle fistulas after cardiac surgery. Am Heart J 122(6):1759–1762CrossRefPubMed Jebara VA, Sarkis A, Acar C et al (1991) Coronary artery-left ventricle fistulas after cardiac surgery. Am Heart J 122(6):1759–1762CrossRefPubMed
13.
Zurück zum Zitat Wright DH, Nipper M, Baisden CE (1994) Left ventricular-coronary sinus fistula after mitral valve replacement: case report and ultrafast CT findings. J Thorac Imaging 9(2):85–87CrossRefPubMed Wright DH, Nipper M, Baisden CE (1994) Left ventricular-coronary sinus fistula after mitral valve replacement: case report and ultrafast CT findings. J Thorac Imaging 9(2):85–87CrossRefPubMed
14.
Zurück zum Zitat Lin C, Lin T (2009) The current status of coronary artery fistula. J Intern Med Taiwan 20(6):484–489 Lin C, Lin T (2009) The current status of coronary artery fistula. J Intern Med Taiwan 20(6):484–489
15.
Zurück zum Zitat Gruberg L, Satler LF, Pfister AJ et al (1999) A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature. Catheter Cardiovasc Interv 48(2):214–216CrossRefPubMed Gruberg L, Satler LF, Pfister AJ et al (1999) A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature. Catheter Cardiovasc Interv 48(2):214–216CrossRefPubMed
16.
Zurück zum Zitat Ata Y, Turk T, Bicer M et al (2009) Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg 4:62CrossRefPubMedCentralPubMed Ata Y, Turk T, Bicer M et al (2009) Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg 4:62CrossRefPubMedCentralPubMed
18.
Zurück zum Zitat Tami LF (1993) Coronary artery-right ventricular fistula after coronary artery bypass grafting. Clin Cardiol 16(2):155–157CrossRefPubMed Tami LF (1993) Coronary artery-right ventricular fistula after coronary artery bypass grafting. Clin Cardiol 16(2):155–157CrossRefPubMed
19.
Zurück zum Zitat Garrean S, Tshibaka C, Hanhan Z et al (2005) Coronary-pulmonary steal caused by internal thoracic artery-pulmonary artery fistula after coronary artery bypass operations. J Thorac Cardiovasc Surg 130(2):569–571CrossRefPubMed Garrean S, Tshibaka C, Hanhan Z et al (2005) Coronary-pulmonary steal caused by internal thoracic artery-pulmonary artery fistula after coronary artery bypass operations. J Thorac Cardiovasc Surg 130(2):569–571CrossRefPubMed
20.
Zurück zum Zitat Blanche C, Eigler N, Bairey CN (1991) Internal mammary artery to lung parenchyma fistula after aortocoronary bypass grafting. Ann Thorac Surg 52(1):141–142CrossRefPubMed Blanche C, Eigler N, Bairey CN (1991) Internal mammary artery to lung parenchyma fistula after aortocoronary bypass grafting. Ann Thorac Surg 52(1):141–142CrossRefPubMed
21.
Zurück zum Zitat Sandhu JS, Uretsky BF, Zerbe TR et al (1989) Coronary artery fistula in the heart transplant patient. A potential complication of endomyocardial biopsy. Circulation 79(2):350–356CrossRefPubMed Sandhu JS, Uretsky BF, Zerbe TR et al (1989) Coronary artery fistula in the heart transplant patient. A potential complication of endomyocardial biopsy. Circulation 79(2):350–356CrossRefPubMed
22.
Zurück zum Zitat Hajj-Chahine J, Haddad F, El-Rassi I, Jebara V (2009) Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg 35(6):1086–1088CrossRefPubMed Hajj-Chahine J, Haddad F, El-Rassi I, Jebara V (2009) Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg 35(6):1086–1088CrossRefPubMed
Metadaten
Titel
Prevalence of coronary artery fistulae after cardiac surgery
Comparison between coronary artery bypass grafting, valve surgery, and orthotopic heart transplantation
verfasst von
A. Young
R. Cheng
J. Wei
F. Esmailian
J. Currier
B. Azarbal, MD
Publikationsdatum
01.03.2015
Verlag
Urban & Vogel
Erschienen in
Herz / Ausgabe Sonderheft 1/2015
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-014-4053-x

Weitere Artikel der Sonderheft 1/2015

Herz 1/2015 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.