Imaging features of computed tomography coronary angiography in patients with coronary-pulmonary fistula

Abstract

Objective To investigate imaging features of computed tomography coronary angiography (CTCA) in patients with coronary-pulmonary fistula(CPF). Methods The clinical data of 26 patients with CPF diagnosed by CTCA from January 2008 to September 2015 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. The origin and number of coronary artery abnormalities, the coronary artery plaque and stenosis, fistula location, size and fistula morphology, size, secondary changes were observed. Six patients underwent coronary angiography, and the differences between the two methods were compared. Results Twenty-six patients with a total of 44 fistula blood vessels, 13 patients originated from bilateral coronary arteries (all from the bilateral conus), 9 patients originated from left coronary artery (7 patients from left bilateral conus, 1 patient from left blunt branches, 1 patient from left main trunk), 4 patients originated from right coronary artery (all from right bilateral conus). Fistula vascular diameter 4-11 mm, average 7 mm. Eleven patients with coronary plaque formation, 4 patients the stenosis more than 50%. Five patients showed normal vascular morphology, 2 patients were in the form of vascular network, 19 patients with aneurysm formation. All the patients had fistula into the pulmonary trunk. The size of the fistula was 1.2-5.0 mm, average 2.7 mm. Eighteen patients with aneurysm patients could be seen contrast agent concentration. The origin, location, and fistula morphology of the 6 patients who underwent CAG were consistent with those of the CTCA. Conclusions Compared with CAG, coronary artery CTCA is noninvasive, which can provide three-dimensional image and reflect the spatial relationship of vascular variation. It can provide more information about coronary artery-pulmonary artery fistula and can be used as the preferred imaging method for CPF. Key words: Arterio-arterial fistula; Coronary-pulmonary fistula; Coronary angiography; Tomography, X-ray computed