Abstract
The aim of the present study was to retrospectively evaluate the incidence and morphological features of coronary artery fistulas (CAFs) detected by dual-source computed tomography coronary angiography (DS-CTCA). Between January 2011 and January 2013, 19,584 consecutive patients that had undergone electrocardiogram-triggering DS-CTCA were retrospectively reviewed. Image reconstructions were performed and image quality was evaluated. The medical information of the patients with CAF was reviewed from the medical records. Among the 19,584 patients, 66 patients were diagnosed with CAFs by CTCA, including 60 patients with coronary pulmonary artery fistulas (CPAFs) and six with coronary left ventricular fistulas. Therefore, the incidence of CAFs was 0.34%. Image quality was considered to be excellent in 61 patients and moderate in five cases. CPAFs were identified as small and tortuous vessels in 24 patients and dilated vessels close to the surface of the pulmonary artery (PA) in 36 patients. The coronary left ventricular fistulas were identified as dilated vessels that were draining into the posterior wall of the left ventricle. Among the 66 patients, 54 patients had one traceable fistula and the remaining 12 patients were shown to have two fistula vessels. The average diameter of the detected fistulas, measured with CTCA, was 3.1±1.9 mm. A high-density flow jet of contrast agent shunting from the fistula into the low density PA was observed in 46 patients with CPAF. The results indicate that DS-CTCA is a reliable noninvasive tool that allows the accurate delineation of CAFs.
Highlights
Coronary artery fistulas (CAFs), defined as abnormal vascular communications between any coronary artery and any of the cardiac chambers or great vessels, are generally noticed incidentally on diagnostic cardiac catheterization in the adult population [1]
Dual-source computed tomography (DSCT), with two arrays consisting of an X-ray tube and detectors arranged at a 90 ̊ angle and a gantry rotation time of 330 msec, allows temporal resolution of 83 msec and provides higher image quality compared with multi-detector CT
19,548 patients that had undergone dual‐source computed tomography coronary angiography (DS‐Computer tomography coronary angiography (CTCA)) were included in the study, which to the best of our knowledge is the largest study cohort from two centers
Summary
Coronary artery fistulas (CAFs), defined as abnormal vascular communications between any coronary artery and any of the cardiac chambers or great vessels, are generally noticed incidentally on diagnostic cardiac catheterization in the adult population [1]. Due to the complex structural anatomy and the probability of the multiple fistulas arising from different segments of the coronary arteries and coronary sinuses, conventional coronary angiography (CAG) may not be sufficient. Computer tomography coronary angiography (CTCA) non‐invasively demonstrates the origin, structural anatomy of coronary, and is easy to follow-up [2]. Dual-source computed tomography (DSCT), with two arrays consisting of an X-ray tube and detectors arranged at a 90 ̊ angle and a gantry rotation time of 330 msec, allows temporal resolution of 83 msec and provides higher image quality compared with multi-detector CT. Few reports focus on the value of DSCT evaluation of CAFs. In the present study, we aim to evaluate the incidence and morphologic features, imaging quality of CAF by the dual-source CT coronary angiography (DSCT)
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