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Gasser S et al.  
Iatrogenic Coronary Fistula in Post Transplant Patients: Pathogenesis, Clinical Features and Therapy

Journal of Clinical and Basic Cardiology 2003; 6 (1-4): 19-21

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Fig. 1: Koronarfistel Fig. 2: Koronarfistel Fig. 3: Koronarfistel

Keywords: CoilEmbolisationHerztransplantationKardiologiekoronare FistelcardiologyCoilcoronary fistulaEmbolisationheart transplantation

Iatrogenic coronary artery fistulae in post transplant patients occur in approximately 8 % of cases. This aspect of post-transplant complication has received little attention so far and there is no review in all the literature which focuses on this particular aspect. The impact of such coronary fistulae on NYHA stage and life expectancy seems to vary considerably and quite likely depends on the type of fistula, its site of drainage, its shunt volume and other preexisting cardiac conditions like coronary artery disease or congestive heart failure. The observation that the life-span is generally shortened in patients with congenital coronary fistulae argues in favour of closing post-endomyocardial biopsy fistulae. The additional risk of decreased LV ejection fraction resulting from rejection would also support this approach. The fact that coil embolisation is successful, simple and complications have not been reported in literature would suggest this method as an appropriate means, especially if an obviously large flow into the right ventricle is seen. Here, we try to summarize the cases reported in literature and look at this feature of cardiac transplantation under the particular aspect of treatment options.
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