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A seemingly random arterial abnormality that can cause heart attack and sudden death in adults with no previous symptoms may not be so random after all. A group of researchers in the Netherlands discovered that many people with congenital aneurismal fistulas share traits that may help doctors prevent attacks by identifying and treating patients at risk. They reported their findings in Congenital Heart Disease.

The authors were inspired to search the medical literature after encountering a 62-year-old Asian woman with a rare coronary artery fistula. A fistula is an abnormal link between blood vessels. The patient's fistula connected her left anterior descending coronary artery and pulmonary artery. Published cases revealed that the left coronary artery is the most common origin of coronary artery fistulas. The authors also learned from the literature that 19 percent to 26 percent of these fistulas have aneurysms, or weakening in the blood vessel wall. Aneurysms that rupture are typically the saccular type.

Case studies showed that Asians are nearly twice as likely to have the congenital abnormality as Caucasians, and that women are more prone to it than men. Most are diagnosed in infancy or childhood. Those who aren't may live for decades with few if any symptoms. A common risk factor the researchers found in their literature search is hypertension.

Coronary artery fistulas can be spotted through an arteriogram, an x-ray using injected dye to reveal blood vessels. Treatment normally involves surgery or insertion of coils via a catheter fed through an artery in the arm or groin.

"Early detection, diagnosis and treatment of congenital aneurismal fistulas can prevent rupture, cardiac tamponade and death," said lead researcher Salah Said, M.D., Ph.D.