Bilateral Coronary Artery Fistula.

Coronary artery anomalies include anomalies of origin, termination, structure or course. Coronary artery fistulae (CAF) are classified as abnormalities of termination and are considered a major congenital anomaly. A coronary artery fistula involves a sizable communication between a coronary artery, bypassing the myocardial capillary bed and entering either a chamber of the heart (coronary-cameral fistula) or a great vessel. Bilateral coronary artery fistula, are a rare variant. We describe a bilateral CAF with angina and significant coronary artery disease requiring percutaneous coronary intervention.

A Clinical and Angiographic Profile and Assessment of Outcomes in Coronary Artery Ectasias: Single Centre Experience.

OBJECTIVE: To assess the clinical and angiographic profile of patients with coronary artery ectasias (CAE) and assess their outcomes. METHODS: One year retrospective and one year prospective study was carried out in the Department of Cardiology in CMC, Ludhiana from January 2011 to December 2012 on all patients undergoing coronary angiographies and each patient was followed up for 1 year. Their outcomes were noted and statistical analysis carried out. RESULTS: There were a total of 327 males (66.3%) and 166 females (33.7%) in the study. Mean age of patients were 51 to 60. The incidence of CAE was 79 (16.02%). 6.9% patients had pure ectasia without CAD. The distribution of CAE according to Markis classification was, Type 1 in 21 (26.5%), Type 2 in18 (22.7%) and Type 3 in 28 (35.44%) and Type 4 comprised of 12 (15.18%). Among all 3 categories UA was the commonest presentation (p=0.004). Hypertension was the commonest risk factor in both patients with CAE (44 patients, 55.7%) and CAD (167 patients, 52.6%) but not statistically significant. Regarding outcomes among Type 1, 84% patients remained asymptomatic, while 8.8% of patients were symptomatic with UA episodes. 4% were lost to follow up. Among Type 2, 68.8% remained asymptomatic while 24.4% had recurrence of symptoms. 6.6% were lost to follow up. Among the Type 3, 70.12% of patients remained asymptomatic while 20.12 % had recurrence of symptoms, 8.17% were lost to follow up. Five patients (1.57%) expired, all of whom were from Type 3. Most patients improved with the treatment opted by them over a 1 year period however the patients that remained symptomatic on treatment were three (8.8%) in category 1, 12 (24.4%) in category II and 55 (20.12%) in category III. Four in Category II required repeated hospitalization while 16 in category III required rehospitalizations. CONCLUSIONS: CAE is not an uncommon finding among patients presenting with acute coronary syndromes requiring invasive evaluation to confirm disease severity and decide management. However it is a benign entity requiring optimal medical management.