Catheterization and Cardiovascular Diagnosis 3 5 116-120 (1995) Coronary Artery Fistulas in Adults: Incidence, Angiographic Characteristics, Natural History Manolis Vavuranakis, MD, Charles A. Bush, MD, and Harisios Boudoulas, MD The incidence, angiographic characteristics, and natural history of coronary artery fis- tulas in patients undergoing diagnostic cardiac catheterization have not been well de- fined. Of 33,600 patients who had diagnostic cardiac catheterization, 34 (0.1%) had cor- onary artery fistula. Nineteen fistulas originated from the right, 11 from the left anterior descending, and 4 from the circumflex coronary arteries, respectively. The mean ratio of pulmonary to systemic flow was 1.19 ~t: 0.33. Only one patient with coexistent atrial septa1 detect had a pulmonic to systemic flow ratio >1.5. Right and left heart pressures, with the exception of three patients in whom left ventricular end-diastolic pressure was >12 mm Hg, were within normal limits. During a mean follow-up period of 6.3 years (range 2-14 years), there were no complications related to coronary artery fistula. It was concluded that the incidence of coronary artery fistulas detected during diag- nostic coronary angiography is very low. Coronary artery fistulas originate predomi- nantly from the right coronary artery and are not associated with hemodynamic abnor- malities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good. o 1995 Wiley-Liss, inc. Key words: congenital, hemodynamics, intracardiac shunt INTRODUCTION Coronary artery fistula can be defined as a direct com- munication of a coronary artery with a cardiac chamber, great vessel, or other vascular structure, bypassing the myocardial capillary bed. The number, origin, and course of the coronary arteries are otherwise normal The prevalence of coronary artery fistulas in a nonse- lected population who had diagnostic coronary arteriog- raphy, and the natural history of coronary artery fistulas in the adult population have not been well defined [3,4]. Cardiac morbidity associated with coronary artery fistu- las has been reported mostly in the pediatric population, but studies related to complications of coronary artery fistulas in adults are lacking [3,4]. The present study was undertaken to define the incidence, the clinical and an- giographic characteristics, and the natural history of cor- onary artery fistulas in adult patients who underwent di- agnostic cardiac catheterization. [1,21. PATIENT POPULATION AND METHODS Patient Population Thirty-three thousand and six-hundred consecutive pa- tients who underwent diagnostic cardiac catheterization from January 1980 until July 1993 at The Ohio State University Medical Center were evaluated. A computer- based data bank is available in the Division of Cardiol- ogy at The Ohio State University Medical Center. This computer program was self-developed and contains com- prehensive information for all patients undergoing any procedure in the cardiac catheterization laboratory. Data regarding age, sex, symptoms, anthropometric charac- teristics, and physical and electrocardiographic findings were stored on all patients who underwent cardiac cath- eterization. Oxygen saturation measurements, hemody- namic measurements, and detailed description of the cor- onary arteries and left ventriculogram were entered into the data bank. Methods Physical examination was performed in all patients by a cardiology fellow and a staff cardiologist prior to car- From the Division of Cardiology, The Ohio State University, Colum- bus. Ohio. Received August 11, 1994; accepted October 24, 1994. Address reprint requests to Harisios Boudoulas, M.D., Division of Cardiology, The Ohio State University, 647 Means Hall, 1654 Upham Drive, Columbus OH 43210. 0 1995 Wiley-Liss, Inc.