Is the Prevalence of Coronary Artery Anomalies Different in Countries with Small Populations? – A Retrospective Study in Northern Cyprus

Background: Although the prevalence of coronary artery anomalies (CAA) is due to accidental and rare discoveries, it varies between different countries or geographies. CAA are rare congenital disorders having various clinical definitions. Its prevalence varies in angiographic and autopsy series in adult populations and is approximately 1% in average. While the incidence ranges from 0.2% to 5.64% in coronary angiographic (CAG) studies, it is around 0.3% in autopsy series. We aimed to estimate the frequency of CAA in our patient population. Methods: The coronary angiographic data of 4099 consecutive adult patients, who underwent CAG between January 2019 and December 2020, were analyzed and retrospectively studied. Results: The mean age of the total patients who underwent CAG was 61.59 ± 13.67 years (range, 18-98 years). CAA were found in 76 patients (1.85% incidence), origin and course anomaly in 62 patients (81.6%), and coronary artery termination anomaly in 14 patients (18.4%). Separate exits of the left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva (LSV) were the most common anomalies (36.84%). Coronary artery fistulas were seen in 14 (18.42%) patients. Abnormal origin of left circumflex artery (LCX) from the right coronary artery (RCA) or right sinus valsalva (RSV) was seen in 13 (17.11%) patients. Outflow anomalies from the contralateral coronary sinus were detected in 10 (13.16%) patients. Conclusion: The incidence and pattern of CAA in our patient population showed similarity with previous studies. Physicians should be aware of CAA that may be associated with potentially serious cardiac incidents, because recognition of these CAA is important for the decision of treatment procedures.

CORONARY ARTERY FISTULA, WHERE ARE WE NOW?''

In the study “Long-term outcomes following surgical repair of coronary artery fistula in adults”, Wada and associates, retrospectively evaluated 13 consecutive patients that underwent surgical repair of CAF No deaths, significant ST-T changes or CAF-related events were reported in a follow-up period of 66.2 months, and 1 patient showed poor contrast RCA#2 on postoperative coronary CT with a myocardial scintigraphy showing no significant change compared to the preoperative state Coronary artery fistulas (CAF) are rare congenital or acquired malformations in the connection of the coronary vessels, first described by Krause in 1865 (2). They can be classified as coronary-cameral fistulas, which connect coronary arteries with any of the heart chambers, or coronary artery malformations, which connect coronary arteries with systemic or pulmonary vessels. Congenital CAFs are normally a result of abnormal embryological development, acquired CAFs are commonly a result of cardiac traumatic injuries, and iatrogenic CAFs are usually a result of interventional cardiac procedures. This condition is still highly undiagnosed, as around 75% of incidentally-found CAFs are small and clinically silent, but it is estimated that CAFs are present in about 0.9% of the general population In our experience, we have a CAF incidence of 0.05% in 10,000 cardiac surgeries, which have demonstrated beneficial outcomes of the surgical repair of CAFs in adults . Authors of this article must be congratulated for the successful development of the study and for the contributions to the literature on this rare condition

Coronary artery fistulas after paediatric heart transplantation

ABSTRACT Coronary artery fistulas have been described in patients after heart transplantation more often than in the normal population. We reviewed our centre’s database between 2008 and 2020. Thirty patients had coronary angiography and 13 showed non-cameral coronary artery fistulas in their first coronary angiography. Distribution, degree and evolution of the fistulas and characteristics of transplant procedure, patient and immunosuppressive treatments were analysed.

CORONARY ARTERY FISTULA IN ELDERLY PATIENT WITH ACUTE CORONARY SYNDROME: A CASE REPORT

Coronary artery fistulas are congenital or acquired abnormality connections between coronary arteries and other structures. Most patients with coronary fistulas are asymptomatic. An 80-year-old man complained of exercise-induced chest pain. A coronary angiogram on PCI and CTA confirmed stenosis on LAD and a large fistula between the coronary artery and the anterior side of the main pulmonary artery. A transcatheter procedure was successfully conducted. In patients with symptomatic fistula or cases with a complication, cardiac intervention is recommended as the primary treatment. Percutaneous catheterization is the preferred treatment.

Case report of a coronary artery-right ventricular fistula following repeat endomyocardial biopsies in a heart transplant patient

Background Endomyocardial biopsy (EMB) remains the gold standard for cellular rejection surveillance in heart transplant recipients. Coronary artery fistula formation is a rare late and potentially catastrophic complication of repeated endomyocardial biopsies, without contemporary evidence on incidence or management. Case summary A 47-year-old male was found to have a fistula between his right ventricle and his left anterior descending artery on an angiogram that was performed as a part of regular screening of coronary allograft vasculopathy. Given the low shunt fraction, asymptomatic nature, and lack of guidelines on definitive management, the patient is undergoing conservative management with regular surveillance. Discussion Coronary artery fistulas were once thought to be rare complications of repeated EMB, but the true prevalence is likely to be higher than previously believed. Ideal treatment and monitoring is unknown given the relative rarity of the condition.