Author/Editor		Cijan, Andrej
Title		Prirojene arteriovenske koronarne fistule
Translated title		Congenital coronary artery fistulae
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 68, št. 10
Publication year		1999
Volume		str. 563-7
Language		slo
Abstract		Background. Congenital anomalies of coronary arteries occur in 1-2% of the population. Coronary artery fistula (CAF) comprise 48% all congenital anomalies. They can be complicated by intracardiac shunts, endocarditis, myocardial infarction or coronary aneurisms. In most cases, this anomaly is found by chance by coronary arteriography, which is considered to be the most reliable method for making correct diagnosis. Patients and methods. This paper describes the clinical picture of CAF, diagnostic procedures and results in our catheterization laboratory. An overal incidens was 0.12%. From year 1982 to 1999 we detected 13 patients with CAF, 7 patients in last 4 years, as the result of more intensive diagnostic procedure and better technology. In patient angina pectoris was the leading symptom, except 2 patients who undewent diagnostic catheterization and coronary arteriography owing to the mitral valve disease. In 2 patients left to right shunt was detected of greater mangitude. 4 patients has fistula alone and in 1 patient we found multiple fistulas. 7 patients were surgicaly treated. There were no operative or late death. No patients has residual or recurrent coronary arteryfistula as noted by late evaluation. In 4 patients coronary angioplasty was done. 2 patients remain on therapy with medicaments. We present in this paper also the three interesting cases with CAF and coronary artery disease. Conclusions. To prevent catastrophic outcomes, surgical treatment of CAF in adults should be performed whenever the precise diagnosis has been established. In the young patients a percutaneous closure of fistula is possible.
Summary		Izhodišča. Prirojene napake na koronarnih arterijah se pojavljajo v 1-2% bolnikov, ki so bili pregledani zaradi sindroma angine pektoris. V skoraj polovici teh primerov gre za prirojene koronarne arteriovenske fistule (CAF). Bolnikom povzročajo angini pektoris podobne težave, potekajo pa z resnimi zapleti, kot so endokarditis, miokardni infarkt, motnje ritma in anevrizma koronarne arterije. Povzročajo lahko tudi pomemben levo-desni spoj (preliv, shunt). Koronarografija je najbolj primerna metoda za odkrivanje teh napak. Postavitev točne diagnoze je pomembna, ker so te napake dostopne operativnemu zdravljenju. Bolniki in metode. Opisana je klinična slika CAF diagnostični postopki in rezultati preiskav v našem kateterizacijskem laboratoriju ter način zdravljenja. CAF smo odkrili v 0,12% pregledanih bolnikov v zadnjih letih. Bilo je 13 bolnikov. Sedem smo jih odkrili v zadnjih štirih letih, verjetno zaradi večje pozornosti, natančnejših preiskav in boljše tehnologije. Glavni bolezenski znak je angina pektoris, kar je bil tudi vzrok za koronarografijo pri enajstih bolnikih. Pri dveh pa je bila ta narejena v sklopu diagnostičnih preiskav zaradi klinično ugotovljene okvare mitralne zaklopke. Dva bolnika sta imela pomemben levo-desni spoj (preliv, shunt), pri štirih smo ugotovili samo obstoj CAF. En bolnik je imel več fistul. Pri sedmih bolnikih smo indicirali operativno zdravljenje, ki je potekalo brez kasnejših zapletov. Pri štirih bolnikih, ki so imeli še dodatno okvaro na koronarni arteriji, smo izvršili koronarno angioplastiko prizadete arterije. Dva bolnika sta ostala na zdravljenju z zdravili. V prispevku so prikazani tudi trije primeri CAF in dodatne koronarne bolezni. Zaključki. Ugotovitev, da gre za koronarno arteriovensko fistulo, je za bolnika zelo pomembna, ker je nadaljni potek bolezni negotov in možnost zapletov zelo velika.
Descriptors		CORONARY VESSEL ANOMALIES ARTERIOVENOUS FISTULA CORONARY ANGIOGRAPHY ANGINA PECTORIS