Coronary-to-pulmonary artery fistula in adults: Natural clinical history and management strategies

Abstract

Purpose/Objectives To evaluate the natural history of coronary-topulmonary artery fistula (CPAF) detected on coronary CT angiography(CCTA) and propose potential treatment strategies. Methods & Materials We conducted a retrospective multicenter study in 168 CPAF patients collected by review of CCTA reports. Thirty-seven patients were excluded because they had less than 2 years of the follow-up period. Finally, 131 patients were included. Data regarding demographics and clinical history were obtained by reviewing electronic medical records. The treatment administered after the diagnosis of CPAF and the occurrence of major adverse cardiac events (MACE) during the follow-up period were investigated. We analyzed the morphological features of CPAF and evaluated the association between fistula size and surgical ligation. Patients who underwent follow-up CCTA after the CPAF diagnosis were assessed for the morphological change and time interval between diagnosis and last follow-up imaging. Results The median age of the study population was 63 years (57–72), and the median follow-up period was 5.72 years (4.08–6.96). There were 65 men and 66 women. Eight patients underwent surgery and 123 (93.9%) patients were observed with optimal medical treatment (OMT). The most common origin of the CPAF was both coronary arteries, with 76 (58.0%) cases. Aneurysm was present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. The fistula size (OR 1.120) significantly associated with surgical treatment (p = 0.028). Only one patient in the observed with OMT group reported MACE during the follow-up period due to pre-existing coronary artery disease. Twenty-eight patients (21.3%) underwent follow-up CCTA after CPAF diagnosis with 3.81 years of the median time interval. There was no morphological change of CPAF. Conclusion Most CPAFs detected by CCTA are usually benign prognosis and OMT is sufficient. Continued symptoms and fistula size are possible determinants for surgical treatment.