Abstract 14063: Frequency of Coronary Artery Fistulae and Extracardiac Neovascularization After Orthotopic Heart Transplantation
Introduction: Coronary artery fistula (CAF) is a rare coronary anomaly occurring in 0.2-0.3% of patients (pts). Orthotopic heart transplantation (OHT) may be associated with a higher frequency of CAF formation. The purpose of this study was to examine the frequency of CAF in a large cohort of OHT pts.
Methods: We evaluated 368 consecutive coronary angiograms of OHT recipients transplanted between 1994-2010. Presence, type, size, and time to development of CAF were determined.
Results: A total of 155 CAF (coronary cameral or coronary arteriovenous connections) or extracardiac neovascularization (anomalous connection without obvious drainage into a venous structure) were identified in 116 pts (31.5% of total) (Table 1). CAF to the right ventricle (possibly iatrogenic due to endomyocardial biopsy) were present in 9 pts (7.8%). Transplant age, donor age, and ischemic time were not significantly different between the pts with fistulae and those without. 96% of CAF were present by year 1 post OHT. No further increase of CAF size was noted beyond year 1. No CAF was associated with clinical events, and all were managed conservatively.
Conclusion: CAF occur with a high frequency in OHT pts. CAF to the right ventricle occur in <10% of the fistulae, suggesting that the predominant mechanism for CAF formation is unrelated to endomyocardial biopsy. The implications of this finding will require further investigation.
- © 2011 by American Heart Association, Inc.