Congenital coronary artery-left ventricle direct micro-fistulas may cause effort angina and positive stress tests in Western adults

Coronary artery anomalies (CAAs) occur in 0.64 % to 5.6% of patients undergoing coronary angiography. Most pathophysiology and clinical histories involving CCAs have been fully clarified in the past 30 years. Isolated congenital coronary artery-left ventricle direct microfistulas (CVmF) have been recently described, but the clinical significance and anatomical characteristics associated with this rare type of CAA in a western population are still unclear. The aim of our retrospective, single center study is to assess the clinical significance and anatomical features associated with this anomaly in a western population.  We retrospectively reviewed the medical records of 17,892 patients (mean age 74.8 ± 22.3 years, 56.8% males) who underwent coronary angiography in our secondary referral center during the past 12 years from July 2003 to July 2015. Patients were analyzed for medical history, classical risk factors, medical instrumental examinations prior to coronary angiography. Coronary angiographies were reviewed by two independent and blinded observers with < 10 years expertise in coronary angiography (inter-observer agreement was 99.8%). The population with the targeted anomaly was compared with a population with normal coronary arteries and no epicardial coronary atherosclerosis by coronary angiography during a period of three months in 2015. Normal coronary artery was define as a vessel with < 10% of lumen narrowing. Chi-square, Fisher exact test and Student-t tests were used to compare frequencies and continuous variables between the groups. Statistical analysis was performed using a statistical software package (SAS for Windows, version 8.2; SAS Institute; Cary, NC USA). A probability value of P< 0.05 was considered to be statistically significant. Sixty-five patients (male/female: 34/31) had angiogra-