Closure of coronary artery fistulas
Coronary artery fistulas (CAFs) (also known as coronary arteriovenous malformations) are a communication between the coronary artery and a segment of the systemic (artery or vein) or the pulmonary artery (including the coronary sinus) or any of the four cardiac chambers of the heart. If the connection is to one or multiple chambers of the heart, it is termed a coronary-cameral fistula. A CAF was described by Krause in 1865.1 A patho-
logic description of a CAF was first given in 1908 by Maude Abbott. It was almost 40 years later that the first report of surgical closure of a fistula was reported by Bjork and Craaford, in a patient whose preoperative diagnosis was patent ductus arteriosus. CAF is a rare anomaly, and the majority of them
are benign in nature and do not cause hemodynamic issues. Clinical examination is consistent with a continuous murmur heard over the precordium, mimicking patent ductus arteriosus. The timing and quality of the murmur are dependent upon the drainage site of the fistula. In some patients, CAFs can cause symptoms. The
symptoms depend upon the size of the fistulous communication. Some patients exhibit signs of congestive heart failure after birth. These patients have large communication to the right ventricle or pulmonary artery with significant left to right shunt, left ventricle volume overload, and perhaps coronary steal. In others, the communication becomes more evident later in life, with symptoms of vague chest pain.