[Left coronaro-ventricular microfistula].

Abstract

Microfistulae between coronary arteries and left ventricle have long been regarded as mere curiosities, but their frequency seems to have been underestimated. A review of 2,520 consecutive coronary arteriographies performed in adults has yielded 34 cases. In most of the 28 patients without infarction or valve disease, the symptoms were suggestive of coronary pathology. Signs of ischaemia were found at electrocardiography in 19 of these 28 patients, and exercise tests or myocardial scintigraphy were positive in 2 out of 3 cases. Patients' mean age was 53.4 years. The coronary arteriographic diagnosis was usually easy when technical conditions were perfect. The division of patients into two groups according to the presence or absence of significant coronary lesions revealed that the "isolated microfistulae" group was primarily composed of women (19/21). It is generally accepted that these fistulae are of embryonic origin, but their relation to atherosclerosis needs to be determined. The causes of ischaemic manifestations (coronary artery steal, global disturbances of myocardial microcirculation) are considered. Treatment is essentially medical, surgery being exceptional. Prognosis is habitually favourable (mean follow-up 28.3 months in our series). Thus, microfistulae between coronary arteries and left ventricle usually present as angina-like symptoms in women in their fifties who are free from atheromatous disease. They are found in more than 1 p. 100 of coronary arteriographies in adults, i.e. 8 p. 100 of "normal" coronary arteriographies. Their origin, the mechanisms of their symptoms and their relationship with the "so-called healthy coronary arteries angina" are obscure.