Purpose of Review

This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults.

Recent Findings

CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management.

Summary

CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.

中文翻译：

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成人先天性冠状动脉瘘的诊断和治疗

审查目的

这篇综述描述了成人先天性冠状动脉瘘（CAF）的表现、诊断和治疗。

最近的发现

CAF 分为冠状动脉瘘或冠状动静脉瘘。远端冠脉床的瘘管连接更可能是动脉瘤，血栓形成和心肌梗塞 (MI) 的风险更高。中型至大型或有症状的 CAF 可表现为缺血、心力衰竭和心律失常。当出现不良冠状动脉重构的归因症状或证据时，建议进行 CAF 封堵。通常可以使用经导管技术实现闭合，但大的瘘管可能需要通过旁路手术结扎。鉴于其解剖结构的复杂性，具有多平面 3D 重建功能的心脏 CT 可以增强 CAF 闭合的程序规划。抗血小板和抗凝是 CAF 治疗的重要治疗方法。

概括

CAF 是一种罕见的心脏异常，具有多样的表现和复杂的解剖结构。CAF 管理策略包括无限期药物治疗、经皮或手术 CAF 封堵以及患者终身监测。