{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T16:46:20Z","timestamp":1782578780698,"version":"3.54.5"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We conducted a systematic review to evaluate the clinical features, diagnosis, and treatment of coronary artery to pulmonary artery fistula (CPAF) and its associated aneurysms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Our search encompassed MEDLINE\/PubMed, Scopus, Google Scholar, and the Cochrane Collaboration Database from 1970 to 2025.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 461 cases were analysed. The volume of publications steadily increased after 2010. The left anterior descending coronary artery was the most common site of origin for CPAF. A total of 457 cases underwent coronary angiography confirming CPAF, with computed tomography coronary angiography being the most frequently used non-invasive imaging modality (190 cases, 41.2%). Stress tests were conducted in 78 cases (16.9%), revealing a coronary steal phenomenon associated with CPAF. Particularly, when comparing aneurysm CPAF to non-aneurysm CPAF, we found that older age is an independent risk factor for developing an aneurysm. For interventions, the symptomatic patients were more likely to close the fistula. We identified that 218 cases (49.7%) underwent surgical treatment, while 121 cases (27.6%) received percutaneous embolization. There were 8 reported deaths, resulting in a mortality rate of 1.8%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The clinical presentations of CPAF are often non-diagnostic. Computed tomography coronary angiography is the preferred method for visualizing the fistulas and their surrounding structures. Surgical treatment is beneficial in cases of aneurysm CPAF or with other surgical indications. Transcatheter closure of CPAF may be considered for selected individuals with favourable anatomy (PROSPERO Number CRD42025643603).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Registration Number<\/jats:title>\n                  <jats:p>PROSPERO Number CRD42025643603.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf206","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T15:26:56Z","timestamp":1758641216000},"source":"Crossref","is-referenced-by-count":1,"title":["A Systematic Analysis of Coronary to Pulmonary Artery Fistula and Its Associated Aneurysm in Adults"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7251-8094","authenticated-orcid":false,"given":"Chaoneng","family":"Wu","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayne","family":"Joseph","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Devireddy","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Kaldas","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Zlatopolsky","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Qaqish","sequence":"additional","affiliation":[{"name":"Cardiology Department, Henry Ford Warren Medical Center , Warren, MI 48093,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunguo C","family":"Gong","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonela","family":"Blaceri","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadi","family":"Saad","sequence":"additional","affiliation":[{"name":"Nephrology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E","family":"Harder","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi A","family":"Saab","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujata","family":"Kambhatla","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Kondur","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garden City Hospital, Michigan State University , Garden City, MI 48135,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"2025092311265391900_ivaf206-B1","first-page":"225","article-title":"On the origin of an accessory coronary artery from the pulmonary artery","volume":"24","author":"Krause","year":"1865","journal-title":"Z Ratl Med"},{"key":"2025092311265391900_ivaf206-B2","first-page":"e698","article-title":"2018 AHA\/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"2025092311265391900_ivaf206-B3","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/0379-0738(95)01721-T","article-title":"Sudden death arising from a congenital coronary artery fistula","volume":"73","author":"Lau","year":"1995","journal-title":"Forensic Sci Int"},{"key":"2025092311265391900_ivaf206-B4","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1510\/icvts.2006.149849A","article-title":"ICVTS on-line discussion A. Coronary artery fistulae: history and surgical experience","volume":"6","author":"Bockeria","year":"2007","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025092311265391900_ivaf206-B5","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1161\/01.CIR.27.5.939","article-title":"Diagnosis and surgical correction of congenital coronary artery-coronary sinus fistula","volume":"27","author":"Haller","year":"1963","journal-title":"Circulation"},{"key":"2025092311265391900_ivaf206-B6","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1186\/s12872-021-02077-4","article-title":"Congenital coronary artery-to-pulmonary fistula with giant aneurysm dilatation and thrombus formation: a case report and review of literature","volume":"21","author":"An","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"2025092311265391900_ivaf206-B7","doi-asserted-by":"publisher","first-page":"2172","DOI":"10.1111\/jocs.16500","article-title":"CTA analysis of 482 cases of coronary artery fistula: a large-scale imaging study","volume":"37","author":"Cai","year":"2022","journal-title":"J Card Surg"},{"key":"2025092311265391900_ivaf206-B8","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2174\/1573403x15666191008100848","article-title":"Coronary fistula between left anterior descending artery (LAD) and pulmonary artery (PA) leading to sudden cardiac death: case report with literature review","volume":"16","author":"Battisha","year":"2020","journal-title":"Curr Cardiol Rev"},{"key":"2025092311265391900_ivaf206-B9","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.circv.2022.08.001","article-title":"Coronary fistula between left anterior descendent artery and pulmonary artery: case report with literature review","volume":"16","author":"Figueroa-Casanova","year":"2023","journal-title":"Cir Cardiovasc"},{"key":"2025092311265391900_ivaf206-B10","doi-asserted-by":"publisher","first-page":"e009516","DOI":"10.1161\/CIRCIMAGING.119.009516","article-title":"Rupture of a coronary artery aneurysm and fistula to the pulmonary artery","volume":"12","author":"Yeung","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025092311265391900_ivaf206-B11","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/S0167-5273(96)02807-0","article-title":"Multiple coronary-pulmonary fistulae involving all three coronary arteries: a case report","volume":"57","author":"Abhyankar","year":"1996","journal-title":"Int J Cardiol"},{"key":"2025092311265391900_ivaf206-B12","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1161\/01.CIR.65.4.810","article-title":"Bilateral coronary artery-pulmonary artery fistulas. Report of five cases and review of the literature","volume":"65","author":"Baim","year":"1982","journal-title":"Circulation"},{"key":"2025092311265391900_ivaf206-B13","doi-asserted-by":"publisher","first-page":"101301","DOI":"10.1016\/j.rmcr.2020.101301","article-title":"Steal and strain: a case of coronary artery fistula presenting with coronary steal syndrome and underlying bronchiectasis","volume":"31","author":"Narh","year":"2020","journal-title":"Respir Med Case Rep"},{"key":"2025092311265391900_ivaf206-B14","doi-asserted-by":"publisher","first-page":"78","DOI":"10.14797\/mdcj-13-2-78","article-title":"Coronary artery fistula","volume":"13","author":"Sunkara","year":"2017","journal-title":"Methodist Debakey Cardiovasc J"},{"key":"2025092311265391900_ivaf206-B15","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/(sici)1522-726x(199902)46:2&lt;143::aid-ccd6&gt;3.0.co;2-e","article-title":"Catheter-based techniques for closure of coronary fistulae","volume":"46","author":"Dorros","year":"1999","journal-title":"Catheter Cardiovasc Interv"},{"key":"2025092311265391900_ivaf206-B16","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jcct.2018.10.013","article-title":"The evaluation of coronary artery-to-pulmonary artery fistula in adulthood on 256-slice CT coronary angiography: comparison with coronary catheter angiography and transthoracic echocardiography","volume":"13","author":"Li","year":"2019","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2025092311265391900_ivaf206-B17","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.ejcts.2010.08.020","article-title":"Left anterior descending artery to pulmonary artery fistula: a rare cause of cardiac arrest","volume":"39","author":"Barbetakis","year":"2011","journal-title":"Eur J Cardio-Thoracic Surg"},{"key":"2025092311265391900_ivaf206-B18","doi-asserted-by":"publisher","first-page":"bcr2015212158","DOI":"10.1136\/bcr-2015-212158(2015)","article-title":"The ominous side of a coronary fistula","volume":"2015","author":"Abreu","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2025092311265391900_ivaf206-B19","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1213\/XAA.0000000000000740","article-title":"Ruptured giant coronary artery aneurysm with coronary artery to pulmonary artery fistula presenting as cardiac tamponade diagnosed by intraoperative transesophageal echocardiography: a case report","volume":"11","author":"Chiricolo","year":"2018","journal-title":"A&A Pract"},{"key":"2025092311265391900_ivaf206-B20","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/j.jaccas.2022.08.026","article-title":"Successful surgical treatment for ruptured aneurysm of Coronary-Pulmonary artery fistula complicated with cardiac tamponade","volume":"4","author":"Shibata","year":"2022","journal-title":"JACC Case Rep"},{"key":"2025092311265391900_ivaf206-B21","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.radcr.2018.10.016","article-title":"Successful transarterial embolization of coronary artery fistula with ruptured aneurysm: a case report","volume":"14","author":"Sakai","year":"2019","journal-title":"Radiol Case Rep"},{"key":"2025092311265391900_ivaf206-B22","doi-asserted-by":"publisher","first-page":"ivad067","DOI":"10.1093\/icvts\/ivad067","article-title":"On-pump beating-heart technique for managing a ruptured left coronary artery aneurysm","volume":"36","author":"Hiromoto","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2025092311265391900_ivaf206-B23","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.jtcvs.2010.10.038","article-title":"Coronary aneurysm with double right coronary artery and fistula","volume":"141","author":"Chen","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025092311265391900_ivaf206-B24","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1159\/000006796","article-title":"Surgical treatment of the coronary artery to pulmonary artery fistulas in adults","volume":"89","author":"Goto","year":"1998","journal-title":"Cardiology"},{"key":"2025092311265391900_ivaf206-B25","doi-asserted-by":"publisher","first-page":"ytae227","DOI":"10.1093\/ehjcr\/ytae227","article-title":"Spontaneous thrombosis of a giant aneurysm complicated with the coronary-to-pulmonary artery fistula: a case report","volume":"8","author":"Takahashi","year":"2024","journal-title":"Eur Hear J Case Rep"},{"key":"2025092311265391900_ivaf206-B26","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.21037\/atm-21-4404","article-title":"Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography","volume":"9","author":"Hang","year":"2021","journal-title":"Ann Transl Med"},{"key":"2025092311265391900_ivaf206-B27","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.jcin.2018.02.041","article-title":"Management of coronary artery aneurysms","volume":"11","author":"Kawsara","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"2025092311265391900_ivaf206-B28","doi-asserted-by":"publisher","first-page":"123","DOI":"10.5114\/aic.2025.147998","article-title":"Percutaneous closure of a hemodynamically significant coronary-pulmonary fistula as a cause of heart failure","volume":"21","author":"Wojciech","year":"2025","journal-title":"Postep Kardiol Interwencyjnej"},{"key":"2025092311265391900_ivaf206-B29","doi-asserted-by":"publisher","first-page":"e28-30","DOI":"10.1016\/j.ijcard.2006.11.108","article-title":"Left main coronary trunk connecting into right atrium with an aneurysm coronary artery fistula","volume":"123","author":"Shiga","year":"2008","journal-title":"Int J Cardiol"},{"key":"2025092311265391900_ivaf206-B30","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3400\/avd.cr.23-00113","article-title":"Coronary-pulmonary artery fistula provides collateral flow to an occluded left anterior descending artery","volume":"17","author":"Takahashi","year":"2024","journal-title":"Ann Vasc Dis"},{"key":"2025092311265391900_ivaf206-B31","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1016\/j.jcin.2021.02.044","article-title":"Coronary artery fistulas: indications, techniques, outcomes, and complications of transcatheter fistula closure","volume":"14","author":"Al-Hijji","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2025092311265391900_ivaf206-B32","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/S0003-4975(10)64245-2(1975)","article-title":"Congenital coronary artery\u2014cardiac chamber fistula: review of operative management","volume":"20","author":"Rittenhouse","year":"1975","journal-title":"Ann Thorac Surg"},{"key":"2025092311265391900_ivaf206-B33","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1161\/CIRCINTERVENTIONS.107.763656","article-title":"Giant coronary artery aneurysm: imaging findings before and after treatment with a polytetrafluoroethylene-covered stent","volume":"1","author":"Eshtehardi","year":"2008","journal-title":"Circ Cardiovasc Interv"},{"key":"2025092311265391900_ivaf206-B34","doi-asserted-by":"publisher","first-page":"ivae095","DOI":"10.1093\/icvts\/ivae095","article-title":"Complete surgical repair for enlarging coronary aneurysm with coronary-pulmonary artery fistula","volume":"38","author":"Masaaki","year":"2024","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2025092311265391900_ivaf206-B35","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1177\/02841851241300332","article-title":"Strategic approach to embolization of coronary to pulmonary artery fistulas: a technical note","volume":"66","author":"Michael","year":"2025","journal-title":"Acta Radiol"},{"key":"2025092311265391900_ivaf206-B36","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1161\/CIRCULATIONAHA.107.714402","article-title":"Pathophysiology of congenital heart disease in the adult part I: shunt lesions","volume":"117","author":"Sommer","year":"2008","journal-title":"Circulation"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/9\/ivaf206\/64245713\/ivaf206.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/9\/ivaf206\/64245713\/ivaf206.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T15:26:57Z","timestamp":1758641217000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf206\/8251531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf206","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,9]]},"article-number":"ivaf206"}}