Coronary artery fistulae: a 10-year review

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Coronary fistulae are abnormal communications between a coronary artery and cardiac chamber or great vessel. Rarely recognized clinically, these uncommon entities are occasionally discovered during the performance of coronary arteriography. Most reported cases of coronary fistulae are associated with a variety of symptoms or complications,1–4 and on this basis some authors advocate surgical repair of all coronary fistulae when discovered. We have found that most fistulae are small and rarely result in symptoms or complications. To study this concept further, we have reviewed the Cleveland Clinic’s ten-year experience with this coronary anomaly.

Methods and materials

The data base consisted of all patients who underwent coronary arteriography at The Cleveland Clinic Foundation from 1971 to 1981. A computerized survey identified patients with coronary artery anomalies including coronary artery fistulae. Cardiac catheterization reports, cineangiograms, and clinical records were reviewed for completeness. Follow-up visits or telephone surveys with the referring physician were undertaken. Repeat coronary arteriography was performed in selected patients.


During the ten-year study, 55,856 patients underwent coronary arteriography at the Cleveland Clinic. Of these, 101 patients (0.2%) were found to have coronary artery fistulae. Sixty-eight of the 101 patients (67.3%) were male and 33 (32.7%) were female. Age ranged from 5 to 74 years with a mean of 53.5 years.

Associated diseases included arteriosclerotic heart disease in 57 patients (56.4%); hypertension in 20 (19.8%); congenital heart disease in 9 (8.9%); and rheumatic heart disease in 8 (7.9%). Twenty-three patients (22.8%) had no associated cardiac diseases.

Eighty patients (79.2%) had . . .



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