Lad-Pulmoner Arter Fistülüne Cerrahi Yaklaşım
Özet
Koroner arter fistülleri koroner arter anomalilerinin bir alt grubu olarak değerlendirilebilirler. Bu grup hastalığın temelinde koroner arterler ile kalbin diğer bölümleri arasında normal fizyolojide olmayan bir bağlantı olması yatar. Sıklıkla konvansiyonel anjiyografi ile tanı alan bu patolojinin yapılan çalışmalarda prevalansının %0,5’e ulaşmadığı raporlanmıştır. Günümüzde koroner Bilgisayarlı Tomografi (BT) anjiyografi kullanımının artmasıyla tanı alma sıklığı artan koroner arter fistüllerinin BT anjiyografiler üzerinden yapılan bir çalışmayla prevalansının %0,88 olduğu belirtilmiştir. Koroner arter fistüllerinin tedavi protokolleri tanı aldığı andaki anatomisine, yarattığı patofizyolojiye ve ek kardiyak patolojilere göre değişebilmektedir. Bu tedavi yöntemleri arasında perkütan girişimlerin yanında cerrahi girişimler de bulunmaktadır. Bazı koroner arter fistüllerini ise medikal takibe bırakmak mümkündür.
Coronary artery fistulas (CAFs) can be considered a subgroup of coronary artery anomalies. These anomalies are characterized by an abnormal connection between the coronary arteries and other cardiac structures, which is not present in normal physiology. Typically diagnosed via conventional angiography, studies report that the prevalence of this pathology is less than 0.5%. However, with the increasing use of coronary computed tomography (CT) angiography in recent years, the detection rate of CAFs has risen. A study utilizing CT angiography reported a prevalence of 0.88% for coronary artery fistulas. The treatment protocols for CAFs vary depending on their anatomy at the time of diagnosis, the pathophysiological impact, and the presence of additional cardiac pathologies. Treatment options include both percutaneous and surgical interventions. In some cases, it is also feasible to manage certain CAFs with medical observation alone.
Referanslar
Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary Artery Fistulas: CT Findings. RadioGraphics. Radiological Society of North America; 2009;29(3):781–9. DOI: 10.1148/rg.293085120
Levin DC, Fellows KE, Abrams HL. Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation. American Heart Association; 1978;58(1):25–34. DOI: 10.1161/01.CIR.58.1.25
Lowe JE, H N Oldham J, D C Sabiston J. Surgical management of congenital coronary artery fistulas. Annals of Surgery. 1981;194(4):373. DOI: 10.1097/00000658-198110000-00001
Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and Types of Coronary Artery Fistulas Detected With Coronary CT Angiography. American Journal of Roentgenology. American Roentgen Ray Society; 2014;203(3):W237–43. DOI: 10.2214/AJR.13.11613
Kanduri J, Falk Z, Singh HS. Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults. Curr Cardiol Rep. 2024;26(5):373–9. DOI: 10.1007/s11886-024-02038-1
Rao SS, Agasthi P. Coronary Artery Fistula. In: StatPearls. [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Nov 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559191/
Ömeroğlu, Suat Nail, Mataracı, İlker, Rabuş, Murat Bülent, İpek, Gökhan, Yakut, Cevat. Sol Ön İnen Arterden Kaynaklanan Koroner Arter Fistülünün Cerrahi Onarımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2005;13(3):303–4.
Verdini D, Vargas D, Kuo A, Ghoshhajra B, Kim P, Murillo H, et al. Coronary-Pulmonary Artery Fistulas: A Systematic Review. Journal of Thoracic Imaging. 2016;31(6):380. DOI: 10.1097/RTI.0000000000000232
Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics. 2018;38(3):688–703. DOI: 10.1148/rg.2018170158
Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary. Circulation. American Heart Association; 2008;118(23):2395–451. DOI: 10.1161/CIRCULATIONAHA.108.190811
Al-Hijji M, El Sabbagh A, El Hajj S, AlKhouli M, El Sabawi B, Cabalka A, et al. Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure. JACC: Cardiovascular Interventions. 2021;14(13):1393–406. DOI: 10.1016/j.jcin.2021.02.044
Referanslar
Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary Artery Fistulas: CT Findings. RadioGraphics. Radiological Society of North America; 2009;29(3):781–9. DOI: 10.1148/rg.293085120
Levin DC, Fellows KE, Abrams HL. Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation. American Heart Association; 1978;58(1):25–34. DOI: 10.1161/01.CIR.58.1.25
Lowe JE, H N Oldham J, D C Sabiston J. Surgical management of congenital coronary artery fistulas. Annals of Surgery. 1981;194(4):373. DOI: 10.1097/00000658-198110000-00001
Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and Types of Coronary Artery Fistulas Detected With Coronary CT Angiography. American Journal of Roentgenology. American Roentgen Ray Society; 2014;203(3):W237–43. DOI: 10.2214/AJR.13.11613
Kanduri J, Falk Z, Singh HS. Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults. Curr Cardiol Rep. 2024;26(5):373–9. DOI: 10.1007/s11886-024-02038-1
Rao SS, Agasthi P. Coronary Artery Fistula. In: StatPearls. [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Nov 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559191/
Ömeroğlu, Suat Nail, Mataracı, İlker, Rabuş, Murat Bülent, İpek, Gökhan, Yakut, Cevat. Sol Ön İnen Arterden Kaynaklanan Koroner Arter Fistülünün Cerrahi Onarımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2005;13(3):303–4.
Verdini D, Vargas D, Kuo A, Ghoshhajra B, Kim P, Murillo H, et al. Coronary-Pulmonary Artery Fistulas: A Systematic Review. Journal of Thoracic Imaging. 2016;31(6):380. DOI: 10.1097/RTI.0000000000000232
Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics. 2018;38(3):688–703. DOI: 10.1148/rg.2018170158
Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary. Circulation. American Heart Association; 2008;118(23):2395–451. DOI: 10.1161/CIRCULATIONAHA.108.190811
Al-Hijji M, El Sabbagh A, El Hajj S, AlKhouli M, El Sabawi B, Cabalka A, et al. Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure. JACC: Cardiovascular Interventions. 2021;14(13):1393–406. DOI: 10.1016/j.jcin.2021.02.044
