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

Acquired coronary artery fistulas(CCFs)are infrequently detected during conventional coronary angiography.To delineate the characteristics of congenital(first part)and acquired(second part)CCFs in adults,a PubMed search was conducted for papers dealing with congenital or acquired CCFs.None of the publications describing patients with coronary-vascular fistulas were included.Papers dealing with pediatric subjects were excluded.From the world literature,a total of 243adult patients were selected who had congenital(n=159/243,65%)and acquired(n=84/243,35%)CCFs.Among the acquired types(n=72,85.7%)were traumatic(iatrogenic(n=65/72,90%),accidental(n=7/72,10%)and(n=12,14.3%)spontaneously developing in relation to severe coronary atherosclerosis or myocardial infarction.A high incidence of spontaneousresolution of iatrogenic CCFs resulting from endomyocardial biopsy or following post-septal myectomy was reported.Spontaneous CCFs associated with myocardial ischemia or infarction resolved completely in 8%of the subjects.Early surgical intervention was the treatment of choice in acquired traumatic accidental CCFs.The congenital types are addressed in a previous issue of this journal(first part).In this review(second of two parts,partⅡ),we describe the acquired coronarycameral fistulas.

Coronary-cameral fistulas in adults(first of two parts)

This is a case series and review of the literature adding11 new cases.Coronary-cameral fistulas(CCFs)are infrequent anomalies which are in general co-incidentally found during diagnostic coronary angiography(CAG).To delineate the characteristics of congenital and acquired CCFs in adults,we performed a PubMed search for papers dealing with congenital or acquired CCFs in adults.Publications on coronary-vascular fistulas or paediatric subjects were not included.From the world literature,a total of 243 adult patients were identified who had congenital(65%)or acquired(35%)CCFs.In this review,which is part one of a two-part series on CCFs,we describe and discuss the congenital fistulas,give an overview on the published literature and report details of our own series of 11 patients with MMFs and solitary macro CCFs.Of the congenital group,56%were small or large solitary macro CCFs(cut-off 1.5mm)and 9%were coronary artery-ventricular multiple micro-fistulas(MMFs).Apical hypertrophic cardiomyopathy was reported in some of the reviewed subjects with MMFs(3/24=13%)but not was seen in our own series.Conservative medical management was generally the treatment of choice in congenital MMFs;prophylactic implantable cardioverter defibrillators(ICD)were implanted in 2/24(8%)of subjects,especially when extensive micro-fistulisations were involved.None of the patients of our own series required an ICD,as the MMFs were of limited size.Congenital or acquired CCFs in adults are infrequent anomalies having a wide spectrum of clinical presentation may varies from asymptomatic to severely devastating states requiring different treatment modalities.

风险评分预测的心血管风险与系列血管内超声检测的冠状动脉左主干斑块发展之间的关系

Background Intravascular ultrasound(IVUS) is increasingly used as an end poin t in studies aimed at reducing progression or inducing regression of coronary ar tery disease. However, data linking serial changes by IVUS with clinical outcome s are scarce. Methods and Results In the absence of a validated risk score for secondary prevention, we compared 3 established risk scores for primary preventi on PROCAM, SCORE, and Framingham with plaque progression and lumen reduction a s assessed with serial IVUS(follow up, 18±9 months) in atherosclerotic left ma in coronary arteries of 56 patients with established atherosclerosis. For all 3 algorithms, patients at highest estimated risk of events showed greater plaque p rogression than patients at lowest risk (P< 0.05 to< 0.01). There were positive linear relationships between the risk of clinical events and plaque progression (r=0.41 to 0.60; P< 0.002 to< 0.0001). This translated into a greater decrease i n lumen dimensions with increasing risk(P< 0.05, PROCAM and SCORE). Risk predict ion using the PROCAM algorithm showed the strongest relation with serial IVUS. D uring follow up, 18 patients suffered from adverse cardiovascular events; these patients had an annual plaque progression that was significantly greater than o ther patients (25.2±19.4%versus 5.9±15.6%,P<0.001). Conclusions There was a positive linear relationship between the estimated risk of clinical events deri ved from all 3 established risk score algorithms and the extent of plaque progr ession measured by serial IVUS. This translated into stenosis progression (reduc tion in lumen dimensions) with increasing clinical risk.

基线斑块负荷与粥样硬化冠状动脉左主干继发重构的关系:一项长期(≥12个月)随访的系列血管内超声研究

目的:Glagov的病理组织学所见和非系列血管内超声研究(IVUS)推断:当动脉粥样斑块负荷达到40%时,代偿性冠状动脉重构便会减少。作者应用系列IVUS对此假设进行检验。方法与结果:应用系列IVUS检查了46例无狭窄的粥样硬化冠状动脉左主干(时间间隔18±8个月),对结果进行分析以评估基线斑块负荷[(斑块面积+中膜面积)/血管面积]和系列重构(基线时血管面积-随访时血管面积)的关系。共有25例基线斑块负荷【40%(30.1%±6.6%,A组),21例基线斑块负荷≥40%(46.1%±5.8%,B组)。