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Diagnostic and therapeutic approach of congenital solitary coronary artery fistulas in adults: Dutch case series and review of literature

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Abstract

Background

Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG).

Aim

To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches.

Materials and Methods

Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous ‘therapeutic’ embolisation (PTE group) or surgical ligation (SL group).

Results

In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one.

Conclusions

Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs.

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Acknowledgement

The assistance of the following catheterisation laboratory technicians in alphabetical order is highly appreciated: Alkmaar, Amsterdam, Apeldoorn, Enschede, Hengelo and Zutphen. Special thanks goes to the staff of the Department of Radiodiagnostics, LUMC; the staff of the laboratory of Nuclear Medicine and Molecular Imaging, UMCG; and the staff of the Department of Cardiac Surgery of St. Antonius Hospital, Nieuwegein. The assistance of librarians Mrs A. Geerdink and Mr D. Maas of hospital ZGT is greatly acknowledged.

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Authors and Affiliations

  1. Department of Cardiology, ZGT location Hengelo, Geerdinksweg 141, 7555 DL, Hengelo, the Netherlands

    S. A. M. Said & R. L. G. Nijhuis

  2. Department of Radiology, ZGT location Almelo, Almelo, the Netherlands

    J. W. op den Akker

  3. Department of Cardiology, Medical Center Alkmaar, Alkmaar, the Netherlands

    G. P. Kimman

  4. Department of Cardiology, Medical Spectrum Twente, Enschede, the Netherlands

    K. G. Van Houwelingen

  5. Department of Radiology, Medical Spectrum Twente, Enschede, the Netherlands

    D. Gerrits & A. B. Huisman

  6. Department of Nuclear Medicine and Molecular Imaging, University Medical Center, Groningen, the Netherlands

    R. H. J. A. Slart

  7. Department of Cardiology, Gelre Hospitals, location Apeldoorn, the Netherlands

    D. M. Nicastia & E. M. Koomen

  8. Department of Cardiology, Gelre Hospitals, location Zutphen, the Netherlands

    A. C. Tans & N. Y. Y. Al-Windy

  9. Department of Cardiac Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands

    U. Sonker

  10. Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

    T. Slagboom

  11. Department of Cardiology, St. Elisabeth Hospital, Tilburg, the Netherlands

    A. C. B. Pronk

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  1. S. A. M. Said
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  2. R. L. G. Nijhuis
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  3. J. W. op den Akker
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  8. R. H. J. A. Slart
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Correspondence to S. A. M. Said.

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Said, S.A.M., Nijhuis, R.L.G., op den Akker, J.W. et al. Diagnostic and therapeutic approach of congenital solitary coronary artery fistulas in adults: Dutch case series and review of literature. Neth Heart J 19, 183–191 (2011). https://doi.org/10.1007/s12471-011-0088-2

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