Coronary arteriovenous fistulas in adult patients: surgical management and outcomes

Abstract Objective: The aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes. Methods: Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted. Results: A total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation. Conclusion: The decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.

Metabolic syndrome is associated with atrial electrical and mechanical dysfunction

In this study, we aimed to investigate the left atrial [LA] electrical and mechanical functions in patients with metabolic syndrome [MetS]. Subjects and The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays [EDs] were measured with tissue Doppler imaging. P-wave dispersion [Pd] was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS [10.3 +/- 6.3, 21.0 +/- 11.5 and 41.7 +/- 10.8] than in controls [7.4 +/- 5.5, 12.3 +/- 10.4 and 29.2 +/- 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively]. The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volume and left ventricular early diastolic [E] wave velocity/late diastolic [A] wave velocity [E/A] ratios were independent correlates of interatrial ED [p = 0.002, p = 0.001 and p = 0.025, respectively]. This study showed that intra-atrial and interatrial EDs and Pd were prolonged and LA mechanical functions were impaired in patients with MetS