Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2016; 8(10): 596-605
Published online Oct 26, 2016. doi: 10.4330/wjc.v8.i10.596
Congenital coronary artery fistulas complicated with pulmonary hypertension: Analysis of 211 cases
Salah AM Said
Salah AM Said, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands
Author contributions: Said SAM has solely contributed to conception, design, drafting and final approval of the manuscript.
Institutional review board statement: The data of this manuscript are obtained from internet, so it should be excepted from approval of institutional review board.
Conflict-of-interest statement: Author has no conflict of interest in connection with the submitted article. No funding has been obtained.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at salah.said@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salah AM Said, MD, PhD, FESC, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, Geerdinksweg 141, 7555 DL Hengelo, The Netherlands. salah.said@gmail.com
Telephone: +31-88-7085286 Fax: +31-88-7085289
Received: February 12, 2016
Peer-review started: February 16, 2016
First decision: March 23, 2016
Revised: July 26, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 26, 2016
Processing time: 257 Days and 11.2 Hours
Abstract
AIM

To compare the behavior of pulmonary hypertension (PHT) associated with coronary artery fistulas (CAFs) between the Asian and Caucasian subjects.

METHODS

CAFs may be complicated with PHT secondary to left-to-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9 (range 19-83) and 49.9 years (range 16-85), respectively. In both groups, right heart catheterization was the most commonly (95%) used method for determining pulmonary artery pressure.

RESULTS

From all of the reviewed subjects, PHT was found in 49 patients (23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization (27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious interpretation.

CONCLUSION

The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.

Keywords: Congenital coronary artery fistulas; Congenital anomaly; Pulmonary hypertension; Asian population; Caucasian population

Core tip: Congenital coronary artery fistulas (CAFs) are infrequent but hemodynamically important anomalies which may evolve a myriad of complications, such as myocardial infarction, congestive heart failure, infective endocarditis, aneurysm, rupture, pericardial effusion, arrhythmias and sudden death. In addition, secondary pulmonary hypertension (PHT) may complicate the course of CAFs. Moreover, when monitoring CAF patients, the clinicians responsible for the management of patients with congenital CAFs should be aware of the development of PHT during the course of the disease.