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Coronary artery fistulae

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Abstract

Coronary artery fistulae (CAF) are rare congenital or acquired in which a connection forms between one of the coronary arteries and a heart chamber or with other vessels. This paper describes three cases of CAF along with their initial presentation, imaging findings and management. The first case is a rare form of CAF in which the left circumflex coronary artery fistula empty into left ventricle. We discuss the different types of CAF along with their prevalence and the different imaging tools that could be utilized to identify CAF. There is no unifying consensus on treatment strategy for symptomatic fistulae and we proposed a management algorithm that could be used to make a decision for intervention versus observation. We discuss options for intervention- surgical, catheter-based and medical therapy.

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Abbreviations

AF:

Atrial fibrillation

CAD:

Coronary artery disease

CAF:

Coronary artery fistula

CCF:

Coronary cameral fistula

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

CS:

Coronary sinus

CVA:

Cerebrovascular disease

DM:

Diabetes mellitus

FFR:

Fractional flow reserve

HLD:

Hyperlipidemia

HTN:

Hypertension

LA:

Left atrium

LAD:

Left anterior descending artery

LCA:

Left coronary artery

LCX:

Left circumflex artery

LM:

Left main

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

NSTEMI:

Non-ST segment elevated myocardial infarction

PA:

Pulmonary artery

PDA:

Patent ductus arteriosus

PV:

Pulmonary vein

RA:

Right atrium

RCA:

Right coronary artery

RV:

Right ventricle

TIA:

Transient ischemic attack

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Acknowledgements

We are grateful to the editorial work by Emily Dobbs.

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Authors and Affiliations

  1. Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Mahboob Ali & Mohamed Effat

  2. Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, 45219, USA

    Kamal M. Kassem

  3. Department of Internal Medicine, St Vincent’s Medical Center, Bridgeport, CT, 06606, USA

    Kofi Osei

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  1. Mahboob Ali
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  2. Kamal M. Kassem
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  4. Mohamed Effat
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Correspondence to Mahboob Ali.

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Ali, M., Kassem, K.M., Osei, K. et al. Coronary artery fistulae. J Thromb Thrombolysis 48, 345–351 (2019). https://doi.org/10.1007/s11239-019-01897-8

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