Iatrogenic coronary arteriovenous fistula following percutaneous coronary angioplasty

Traumatic coronary artery fistula management

Traumatic coronary artery-cameral fistulas (TCAF) are uncommon sequelae of trauma that require early surgical intervention to prevent complications. The etiology of traumatic coronary artery-cameral fistulas may be classified as accidental or iatrogenic and have distinctly different courses depending on the etiology. The two operations described for definitive surgical closure of a traumatic coronary-cameral fistula are external ligation/obliteration of the fistula (with or without bypass grafting to the coronary artery distal to the fistula) and direct repair of the fistula from within the recipient chamber. The technique of fistula closure from within the recipient chamber is associated with a reduced incidence of fistula recurrence. A case report and a collective literature review are presented.

Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction

We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.

Coronary artery fistula after heart transplantation: a disappearing entity?

A high incidence of coronary artery fistulas has been observed angiographically after heart transplantation. To determine the present incidence of this finding and the natural history of fistulas in this setting, we reviewed coronary angiograms and clinical course on all patients (n = 480) transplanted from 1980 to 1990 who survived until the first annual coronary angiogram and compared the incidence of coronary artery fistulas in the early (patients #1-160), middle (patients #161-320), and late transplant (patients #321-480) groups. The 3-yr coronary artery fistula incidence for the early group was 3.5%, 6.9% for the middle group, and 2.9% in the late group (P < 0.05, early vs late). Patients who developed fistulas were followed longitudinally. Angiographic follow-up data (median duration: 6 yr) were available in 14 patients having 17 fistulas. No fistula increased in size, and in 10 of 14 patients (71%), fistulas became angiographically undetectable. No patient had any clinical complication related to the fistula. In summary, the incidence of coronary artery fistulas is presently lower than previously reported, which may in turn be related to refinements in heart biopsy technique. The lack of long-term clinical sequelae and the relatively high rate of disappearance favor a conservative approach of "watchful waiting."