Abstract
Coronary pulmonary fistulae are rare abnormalities of coronary artery development, can be combined with other heart defects and, depending on diameter, are hemodynamically significant or not. To date, the question of the role of coronary pulmonary fistulas in the development of acute and chronic cardiac pathology is being discussed.
Purpose. To study the effect of coronary pulmonary fistulas on coronary and systemic hemodynamics, to assess their role in the development of myocardial ischemia.
Materials and methods. Analysis of medical records of inpatients who were treated in cardiology departments No. 1 and No. 2 of the Clinical Emergency Hospital OGBUZ with the study of anamnesis, objective indicators, results of laboratory and instrumental research methods, comparison of the results obtained with literary data.
Results. Coronary pulmonary fistulae accounted for 0.29% of all coronary angiographies performed for acute coronary syndrome and chronic coronary heart disease. Women made up 33.3%, men – 66.7%. Coronary pulmonary fistulas were found mainly in the left coronary artery basin – 83.3% and departed either from the trunk or from the initial segments of the anterior interventricular branch. Fistulas were combined with minor cardiac abnormalities (anterior mitral valve leaflet prolapse) in 33.3%. In 1 patient (16.7%), a large aortopulmonary collateral was found with a significant discharge of blood into the pulmonary artery and the development of pulmonary hypertension. According to the medical history, in 83.3% of patients, clinical manifestations of coronary pulmonary fistulas appeared several days before hospitalization. Of the risk factors for coronary heart disease, 100% of patients had arterial hypertension, dyslipidemia and a decrease in glomerular filtration rate, 50% had diabetes mellitus and obesity, and 33.3% had smoking. In all patients, during the study of brachio-cephalic arteries, a thickening of the intima-media complex was found, in 83.3% atherosclerotic plaques up to 50% of stenosis of the internal carotid artery were detected. 66.7% of patients have chronic heart failure with a decrease in LV EF.
Conclusion. Coronary pulmonary fistulas are often combined with other congenital heart and vascular malformations, which can affect myocardial contractility over time. The clinical manifestations of fistulas depend on its size, the volume of blood discharged and the duration of existence. The development of myocardial ischemia leads to stenosing atherosclerosis and atherothrombosis, which form in the coronary artery basin that feeds the fistula, as well as multiple risk factors for cardiovascular diseases (dyslipidemia, hypertension, decreased glomerular filtration rate, diabetes mellitus, smoking, obesity, male sex, age).
Keywords: coronary pulmonary fistula, myocardial ischemia, coronary artery atherosclerosis.
Purpose. To study the effect of coronary pulmonary fistulas on coronary and systemic hemodynamics, to assess their role in the development of myocardial ischemia.
Materials and methods. Analysis of medical records of inpatients who were treated in cardiology departments No. 1 and No. 2 of the Clinical Emergency Hospital OGBUZ with the study of anamnesis, objective indicators, results of laboratory and instrumental research methods, comparison of the results obtained with literary data.
Results. Coronary pulmonary fistulae accounted for 0.29% of all coronary angiographies performed for acute coronary syndrome and chronic coronary heart disease. Women made up 33.3%, men – 66.7%. Coronary pulmonary fistulas were found mainly in the left coronary artery basin – 83.3% and departed either from the trunk or from the initial segments of the anterior interventricular branch. Fistulas were combined with minor cardiac abnormalities (anterior mitral valve leaflet prolapse) in 33.3%. In 1 patient (16.7%), a large aortopulmonary collateral was found with a significant discharge of blood into the pulmonary artery and the development of pulmonary hypertension. According to the medical history, in 83.3% of patients, clinical manifestations of coronary pulmonary fistulas appeared several days before hospitalization. Of the risk factors for coronary heart disease, 100% of patients had arterial hypertension, dyslipidemia and a decrease in glomerular filtration rate, 50% had diabetes mellitus and obesity, and 33.3% had smoking. In all patients, during the study of brachio-cephalic arteries, a thickening of the intima-media complex was found, in 83.3% atherosclerotic plaques up to 50% of stenosis of the internal carotid artery were detected. 66.7% of patients have chronic heart failure with a decrease in LV EF.
Conclusion. Coronary pulmonary fistulas are often combined with other congenital heart and vascular malformations, which can affect myocardial contractility over time. The clinical manifestations of fistulas depend on its size, the volume of blood discharged and the duration of existence. The development of myocardial ischemia leads to stenosing atherosclerosis and atherothrombosis, which form in the coronary artery basin that feeds the fistula, as well as multiple risk factors for cardiovascular diseases (dyslipidemia, hypertension, decreased glomerular filtration rate, diabetes mellitus, smoking, obesity, male sex, age).
Keywords: coronary pulmonary fistula, myocardial ischemia, coronary artery atherosclerosis.
For citation:Bazina I.B., Kozyrev O.A., Dekhnich N.N., Shchetinkova V.Yu., Rozhkov D.S., Sinitsky A.V., Pavlova M.V., Zubkov S.K. Coronary pulmonary fistulas, their role in impaired coronary and systemic hemodynamics, the development of myocardial ischemia on the example of patients in cardiology departments. Clinical review for general practice. 2025; 6 (3): 6–12 (In Russ.). DOI: 10.47407/kr2024.6.3.00577
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