Coronary Artery Fistula Flashcards
(35 cards)
What is a coronary artery fistula?
An abnormal connection between a coronary artery and a cardiac chamber or another vessel.
What are the two types of coronary artery fistulae?
- Coronary cameral fistula
- Coronary arteriovenous fistula
Where do about 90% of coronary artery fistulae terminate?
On the right side of the heart.
What is the most common cardiac chamber that a coronary artery fistula connects to?
Right ventricle.
What are the possible connections for a coronary artery fistula?
- Right ventricle
- Right atrium
- Pulmonary artery
- Coronary sinus
- Left atrium
- Left ventricle
What percentage of coronary artery fistulae originate from the right coronary artery?
Around 60%.
What percentage of coronary artery fistulae originate from the left coronary artery?
About 40%.
What additional congenital heart diseases are associated with coronary artery fistulae?
- Pulmonary atresia with intact ventricular septum
- Tetralogy of Fallot
- Transposition of the great arteries
- Ventricular septal defect
- Atrial septal defect
- Bicuspid aortic valve
- Coarctation of the aorta
What are some rare causes for the acquisition of a coronary artery fistula?
- Myocardial resection
- Cardiac biopsy
- Ablation
- Tumor
- Trauma
- Myocardial infarction
What is the epidemiological occurrence of coronary artery fistulae in the general population?
About 2 in 1000 people.
What percentage of congenital heart disease do coronary artery fistulae comprise?
Approximately 0.2-0.4%.
Is there any race or gender predominance for coronary artery fistulae?
No.
What embryological concept is thought to explain the formation of coronary artery fistulae?
Persistence of coronary sinusoids or incomplete reabsorption of myocardial trabeculations.
What factors influence the clinical presentation of a coronary artery fistula?
Size and point of termination
Small fistulae are often asymptomatic, while large ones can cause symptoms as early as infancy.
What symptoms may present in patients with a large coronary artery fistula?
Chamber enlargement or heart failure symptoms
Symptoms can appear early in infancy.
What are common symptoms of less significant coronary artery fistulae in adolescence or adulthood?
Murmur, dyspnea, fatigue, or angina
What long-term complications can arise from coronary artery fistulae?
Premature coronary artery disease, endocarditis, fistula rupture, pulmonary hypertension
These complications can occur over time if the fistula is not addressed.
What interventions are considered for hemodynamically significant coronary artery fistulae?
Transcatheter occlusion and surgical ligation
What is a potential outcome following intervention for coronary artery fistulae?
Residual flow or chronic coronary microvascular dysfunction
What hemodynamic impacts are associated with coronary artery fistulae?
Distal coronary insufficiency and shunt, volume load, or runoff
What phenomenon occurs due to distal coronary insufficiency in coronary artery fistulae?
Coronary ‘steal’ phenomenon
When is the coronary ‘steal’ phenomenon most evident?
During increased myocardial demand, such as exercise
What condition can exacerbate the coronary ‘steal’ phenomenon in adults?
Coexisting coronary artery disease
What symptoms can result from fistulae that drain into the right heart and pulmonary artery?
Progressive chamber dilation, increased pulmonary blood flow, pulmonary hypertension
