Coronary Fistula Treatment - Abnormal Vessel Connection Closure

Coronary fistula treatment involves closing abnormal connections between coronary arteries and heart chambers or major vessels.

What is a Coronary Fistula?

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Coronary arteriovenous fistula (CAVF) is an abnormal connection between coronary arteries and cardiac chambers (atrium or ventricle) or structures such as the pulmonary artery or coronary sinus.

Types of Fistulas:

• Coronary-Cameral Fistula: Coronary artery → Cardiac chamber
• Coronary-Pulmonary Fistula: Coronary artery → Pulmonary artery
• Coronary-Coronary Sinus Fistula: Coronary artery → Coronary sinus

Causes of Coronary Fistula

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Congenital (From Birth)

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• Most common cause
• Embryonic developmental anomaly
• Usually single fistula

Acquired

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• Chest trauma
• Post cardiac surgery
• Post coronary interventions
• Myocardial infarction
• Infective endocarditis

Coronary Fistula Classification

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By Drainage Site

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By Size

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• Small fistula: <3 mm
• Medium fistula: 3-5 mm
• Large fistula: >5 mm

Coronary Fistula Symptoms

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Asymptomatic

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Small fistulas often have no symptoms. Discovered incidentally.

Symptomatic

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Large fistulas may present with complaints:

• Dyspnea: Especially with exertion
• Chest pain: Angina-like
• Palpitations: Due to arrhythmia
• Fatigue: Sign of heart failure
• Murmur: Continuous murmur may be heard

Complications

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• Heart failure
• Coronary steal syndrome
• Myocardial ischemia
• Infective endocarditis
• Fistula rupture (rare)
• Aneurysmal dilation

Coronary Fistula Diagnosis

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Physical Examination

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• Continuous murmur
• Heart failure signs

Imaging Methods

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Echocardiography:

• First-line evaluation
• Dilated coronary artery visualization
• Doppler flow detection

Coronary Angiography:

• Gold standard diagnostic method
• Shows fistula anatomy
• Identifies drainage site

Cardiac CT Angiography:

• Non-invasive evaluation
• 3D anatomical imaging
• For surgical planning

Cardiac MRI:

• Shunt quantification
• Functional assessment

Coronary Fistula Treatment

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Treatment Indications

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Conditions requiring treatment:

• Symptomatic patients
• Large fistulas (>3mm)
• Increased left ventricular load
• Coronary steal syndrome
• History of endocarditis

Conservative Follow-up

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For small, asymptomatic fistulas:

• Regular echocardiography
• Endocarditis prophylaxis
• Symptom monitoring

Transcatheter Closure

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Preferred method:

Catheter-based fistula closure:

Devices Used:

• Coils
• Amplatzer vascular plug
• Covered stent

Advantages:

• Minimally invasive
• Short hospital stay
• Low complication risk
• Quick recovery

Procedure Steps:

1. Arterial access (femoral/radial)
2. Selective coronary angiography
3. Wire advancement into fistula
4. Coil or plug placement
5. Control angiography

Surgical Treatment

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Preferred in these situations:

• Very large fistulas
• Aneurysmal dilation
• Transcatheter failure
• Concomitant cardiac pathology

Surgical Techniques:

• Fistula ligation
• Fistula excision
• Combined with coronary bypass

Treatment Outcomes

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Transcatheter Closure

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• Procedural success: >95%
• Complete closure: 90-95%
• Residual shunt: <5-10%
• Major complication: <2%

Long-term Follow-up

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• Echocardiography control
• Residual shunt assessment
• Endocarditis risk monitoring

Frequently Asked Questions

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Appointment and Contact

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To schedule an appointment for coronary fistula evaluation and treatment:

📍 Eurasia Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul

📞 Phone: +90 212 665 50 50 (Ext: 4012)

This content has been prepared by Assoc. Prof. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.

Related Coronary Interventions

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Other services related to coronary fistula treatment:

• Coronary Angiography - Diagnostic coronary imaging
• IVUS - Intravascular ultrasound
• Echocardiography - Cardiac ultrasonography
• Cardiac CT - Computed tomography
• Bifurcation Intervention - Branching site treatment