Coronary artery fistula: To close or not close, that is the question

Prognosis in subjects with coronary artery fistula (CAF) is highly variable. CAF may remain asymptomatic throughout the entire lifetime in some; however, in others, CAF may become hemodynamically significant and complications ensue. CAF closure, either surgically or via a transcatheter approach, eliminates the underlying anatomical anomaly but is associated with a variety of complications, including but not limited to coronary thrombosis and even full-blown myocardial infarction. In this review, we summarize the evidence that argued for versus against CAF closure and attempt to provide a balanced view of the benefits versus harm of CAF closure in patients with different types of CAF.