Coronary-cameral fistulas in adults: Acquired types (second of two parts)

Core Tip

Core tip: The literature addressing acquired coronary artery fistulas (CCFs) is reviewed. A detailed classification of acquired CCFs is attempted. Acquired coronary artery fistulas are subdivided into spontaneous and traumatic types. The traumatic fistulas encounter iatrogenic and accidental subtypes. The iatrogenic fistulas are secondary to non-surgical interventions (endomyocardial biopsy, permanent pacing and implantable cardioverter-defibrillator leads, radiofrequency cardio-ablation, baro-trauma and transseptal puncture) and cardiac surgical procedures (septal myectomy and other cardiac surgical procedures). Diagnosis of acquired CCFs is suspected by clinical history and recurrence of symptoms, occurrence of a new continuous machinery cardiac murmur and a palpable thrill. Watchful waiting and supportive medical management may be advocated in the majority of acquired CCFs. Acquired traumatic accidental CCFs are indications for emergent surgical procedures. Within this entity of CCFs, each subtype has its own specific characteristics such as age of the subjects, origin, termination of fistulas or mechanism of injury and its specific treatment modality.