Coronary artery fistulae without adudible murmur in adults |
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Authors: | S Bhandari MD A Kanojia R R Kasliwal T S Kler A Seth N Trehan M L Bhatia |
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Institution: | (1) Escorts Heart Institute and Research Centre, Okhla Road, 110 025 New Delhi, India |
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Abstract: | Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and
December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36–69 years). No murmur was audible in any
of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries
to the fistula were both the left main coronary artery and the left anterior desending artery (LAD) in two, the LAD in six,
and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the
right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula)
was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up
to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo
surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare
(incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease,
and that the diagnosis is mostly incidental during routine coronary arteriography. |
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Keywords: | Coronary artery fistula Congenital coronary artery fistula Chest pain syndrome Coronary angiography |
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