Diagnosis Of Coronary Artery Fistula Research Articles

Coronary Artery Fistula Following Surgical Myectomy for Hypertrophic Obstructive Cardiomyopathy – A Case Report

Abstract Background Coronary artery fistula is a rare, but recognised complication of surgical myectomy. Although most communicate with the right heart, a large fistula into the left ventricular cavity may result in a shunt haemodynamically analogous to aortic regurgitation. Understanding the variable presentation of iatrogenic coronary fistulae and the optimal evaluation strategy is critical to obtaining a timely diagnosis and instituting treatment. Case Summary We report the case of a 57-year-old renal transplant recipient admitted for evaluation of presyncope, one-year post-surgical myectomy for hypertrophic obstructive cardiomyopathy. An iatrogenic coronary artery fistula was suspected by transthoracic echocardiography, and later confirmed with both non-invasive and invasive coronary angiography. Discussion We highlight various cardiac imaging modalities that confirmed the diagnosis of coronary artery fistula and helped to determine the clinical significance. We report the tailored approach often required to determine the anatomic and haemodynamic characteristics of coronary fistulae and outline potential management strategies.

Coronary Artery to Pulmonary Artery Fistula: A Congenital Rare Defect in Adult. How was it Managed?-A Case Report

Coronary artery fistula (CAF) is a rare anatomic abnormality of the coronary arteries that results from abnormal communication between a coronary artery and either the chambers of the heart or the great vessels that bypass the myocardial capillary bed. It is usually congenital, but it can be acquired. Both male and females are affected. Clinical presentation may be asymptomatic or symptomatic and it depends on the type of fistula, size of the fistula, site of the shunt and severity of the shunt. Coronary angiography is the gold standard for the diagnosis of coronary artery fistula. Surgery is indicated when a patient is clinically symptomatic, even in asymptomatic patients those are at risk for future complications.

Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium

Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.)

Clinical Application Value of SOMATOMForceCTCCTA Examination in the Diagnosis of Coronary Artery Fistula

Clinical Application Value of SOMATOMForceCTCCTA Examination in the Diagnosis of Coronary Artery Fistula

Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review.

Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.

The role of multislice computed tomography in the diagnosis of coronary artery fistulas

This study aims to investigate the frequency and the anatomical features of coronary artery fistulas in patients undergoing multislice computed tomographic angiography for various reasons. Between January 2009 and July 2015, a total of 40 coronary artery fistulas of 26 patients were retrospectively analyzed using multislice computed tomographic angiography in our clinic. The affected arteries and localizations of the fistulas were evaluated. Of the fistulas, 11 (27.5%) were originating from the circumflex artery, 10 (25%) from the left anterior descending artery, four (10%) from the diagonal arteries, three (7.5%) from the left main coronary artery, three (7.5%) from the right main coronary artery, three (7.5%) from the septal artery, three (7.5%) from the conus artery, one (2.5%) from the obtuse marginal artery, one (2.5%) from left anterior descending artery proper (dual LAD), and one (2.5%) from the ramus intermedius. One of the conus arteries was directly originating from the right coronary sinus. Twelve (30%) of the fistulas were draining into the pulmonary trunk, eight (20%) into the left ventricle, seven (17.5%) into the right ventricle, five (12.5%) into the superior vena cava, three (7.5%) into the right main pulmonary artery, two (5%) into the right atrium, one (2.5%) into the left atrium, one (2.5%) into the right internal thoracic artery, and one (2.5%) into the sinus coronarius. Compared to conventional angiography, multislice computed tomographic angiography is a non-invasive modality which allows enhancing coronary artery fistulas at a higher rate and visualizing the cardiac anatomy in detail.

Echocardiographic diagnosis of coronary artery fistula in both dizygotic twin brothers

A congenital coronary artery fistula (CAF) is a rare form of heart disease in which a coronary artery and a cardiac chamber or another vascular structure communicate. CAF could worsen ventricular perfusion and function, favoring ventricular ischemia and arrhythmias. To our knowledge, this is the first report of CAF, draining in the pulmonary artery, in two asymptomatic dizygotic twin brothers, diagnosed by echocardiography. Dizygotic twins are siblings with different genes exposed to the same environmental experience during the pregnancy. The occurrence of CAF (with similar instrumental findings) in both twin brothers could depend on a poorly identified environmental factor during pregnancy.

Coronary artery fistula in adults: evaluation with dual-source CT coronary angiography.

To evaluate the clinical value of dual-source CT (DSCT) coronary angiography in the diagnosis of coronary artery fistula (CAF) in adults. A large cohort of 17,548 patients, who underwent DSCT coronary angiography in our hospital between January 2008 and October 2013, were retrospectively reviewed for CAF. The origin, course and drainage site of CAF and coexisting abnormalities were analysed. The conventional angiography results, treatments and follow-up DSCT images were also evaluated. A total of 33 CAFs from 17,548 patients were detected. The incidence of CAF was 0.19% by DSCT. CAF originating from the left coronary artery (LCA) was found in 14 (42.4%) patients, from right coronary artery (RCA) in 4 (12.1%) cases and from both LCA and RCA in 15 (45.5%) patients. The pulmonary artery was the most common site of drainage (28/33, 84.8%). 8 of the 33 (24.2%) cases were associated with aneurysms. Six cases were associated with coronary artery atherosclerosis. Four patients underwent conventional angiography. Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF commonly originates from LCA or both LCA and RCA in adults. DSCT is a robust tool for investigating the origin, course and drainage site of CAF and coexistent abnormalities. A large adult patient cohort who underwent DSCT angiography was reviewed to assess CAFs. Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF was observed to originate from the LCA or both coronary arteries in adults. DSCT could clearly depict the fistula origin, course, drainage site and coexisting abnormalities. Conventional angiography results, treatments and follow-up DSCT images were analysed.

Coronary artery fistula: Comparison of diagnostic accuracy by echocardiography versus coronary arteriography and surgery in 63 patients studied between 2002 and 2012 in a single medical center in China

BackgroundCoronary artery fistula (CAF) is a rare congenital anomaly, which is conventionally diagnosed by coronary arteriography; however, the relation of the coronary artery fistulas to other structures, their origin and course may not be always apparent. MethodsThe echocardiograms of 63 patients with coronary artery fistulas, who had undergone coronary arteriography and/or surgery from June 2002 to December 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, and the results were compared with findings by coronary arteriography and at surgery. ResultsRight CAFs were detected in 33 of the 63 patients (52.4%); 11 had drainage to the right atrium, 10 to the right ventricle, 2 to the left ventricle, 9 to the main pulmonary artery, and 1 to the coronary sinus. Left CAFs were detected in 29 patients (46.0%); 6 had drainage to the right atrium, 12 to the right ventricle, 1 to the left atrium, 2 to the left ventricle, 7 to the main pulmonary artery, and 1 to the coronary sinus. One patient (1.6%) had the origin of the fistula in both coronary arteries. The entry point of the fistula was most often a single orifice (96.8%) and rarely multi-orificial (3.2%). 57 patients (90.5%) had isolated coronary fistulas (90.5%); 6 patients (9.5%) had other congenital cardiac malformations. The ultrasonic diagnosis of 60 patients was in line with findings at surgery and/or coronary arteriography. The diagnostic accuracy rate for coronary artery fistula was 95.2%. Preoperative transthoracic echocardiography missed the diagnosis of coronary artery fistula in three patients (4.8%). There is no difference (P>0.05) in diagnostic accuracy between echocardiography and coronary arteriography and/or surgery. ConclusionsTransthoracic echocardiography, in comparison with coronary arteriography and/or surgery, is much simpler, easier, less expensive, safer, readily repeatable, and more convenient with equal accuracy, and should be the first-line method for the diagnosis of congenital coronary artery fistula.

Clinical application of dual-source CT in diagnosis of coronary artery fistulas in children

Objective To explore the clinical application of low-dose dual-source CT (DSCT) angiography in diagnosis of coronary artery fistulas (CAF) in children. Methods A total of 22 patients [mean age (3.2 ± 1.5) yrs,age range 1.2-6.0 yrs; male 12,female 10] with CAF who underwent DSCT angiography under free breathing were retrospectively reviewed.Surgery was performed in 9 patients,and transcatheter closure in 13 patients.The diagnostic accuracy of DSCT was evaluated based on the surgical or conventional cardiac angiography (CCA) findings.The subjective image quality was evaluated on a fourpoint scale by two radiologists.Radiation dose values were recorded.Interobserver agreement of subjective image quality grading was assessed by using Kappa statistics.Results All images were diagnosable.The average subjective image quality score was 2.6 ± 0.7.Two radiologists made good agreement (K =0.75,P ＜ 0.05).Twenty-five coronary artery fistulas in all patients were clearly displayed on DSCT images with accuracy of 100％.CAF arose from right coronary artery in 13(59.1％) cases,from left coronary artery in 8(36.4％) cases and from dual coronary arteries in 1 (4.5％) case.There were 4 patients associated with coronary artery aneurysms.The mean dose-length product (DLP) was (25 ± 4) mGy · cm resulting in an estimated mean effective radiation dose of (0.25 ± 0.07)mSv.Conclusion Low-dose DSCT angiography provides accurate and reliable diagnosis for coronary artery fistulas in children. Key words: Coronary vessels ; Vascular fistula ; Tomography, X-ray computed ; Radiation dosage; Child

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

An 86-year-old woman with history of hypertension, diabetes, hyperlipidemia, and coronary artery disease was admitted with new-onset congestive heart failure and pneumonia. She underwent coronary angiography after suffering a non-ST elevation myocardial infarction. There was severe coronary artery disease in addition to coronary artery-pulmonary fistulas involving proximal right coronary artery and a branch of left main coronary artery. Coronary artery fistula (CAF) is an abnormal communication between one or more coronary arteries and great vessels or a cardiac chamber. We reviewed 15 cases of CAFs published in PubMed and studied the clinical features of CAFs.

Coronary artery fistulas in children

There are various types of coronary artery fistulas (CAF) with complex shapes. Therefore, it is important to make a correct diagnosis and to understand the relationship of the CAF to the adjacent structures before transcatheter occlusion or surgery. This study evaluated the feasibility of using 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF. Two readers who were blinded to the results of echocardiography, intervention, or surgery retrospectively evaluated the coronary MDCT appearances of CAF in 10patients (4boys and 6girls; mean age, 2.9years; range, 1-6years). The origin, course, and distal entry site of the fistula were determined. The diameters of the origin and the distal entry site were measured and compared with those seen during intervention or surgery. The origin, course, and distal vessel entry site of the CAF were clearly outlined in all patients by MDCT. The distal vessel draining site involved a single entry vessel in all patients. Seven fistulas involved the right coronary artery, and three involved the left coronary artery. Four fistulas drained into the right ventricle, four into the right atrium, and two into the left ventricle. The diagnosis of CAF using MDCT was in accordance with diagnoses made during intervention or surgery. There was an excellent correlation between MDCT and transcatheter occlusion in quantifying the diameters of the origin and distal entry site (R = 0.90 and 0.92, respectively, P < 0.05). Coronary 64-slice MDCT angiography depicted the whole shape and course of the CAF as well as of the surrounding structures. It may serve as a noninvasive diagnostic tool when planning a therapeutic strategy.

Prenatal diagnosis of coronary artery fistula: A case report and review of literature

Prenatal diagnosis of coronary artery fistula: A case report and review of literature

Assessment of transcatheter closure of coronary artery fistula by transthoracic echocardiography

Objective To investigate the efficacy of transcatheter closure of coronary artery fistula (CAF) by transthoracic echocardiography(TTE) and the role of TTE in this therapy. Methods CAF were occluded with transcatheter closure techniques in 17 patients. TTE was performed before and after the treatments. The key points were retrospectively analyzed including: the sites of CAF, the position and diameter of CAF,the shape and position of the devices after the intervention,the residual shunt,and cardiac chamber size. Results Before the therapy,TTE made definite diagnosis of CAF. All patients had lesions in single coronary artery, and the diameter of CAF was 2-14 (6.4 ± 3.5)mm. All patients underwent transcatheter closure successfully. TTE revealed the shunts disappear 1-4 days after the occlusion. During a follow-up period of 1- 29 (11.7± 7.9)months,no residual shunts, no complications, and normal size of thecardiac chambers were recognized by TTE. Conclusions The transcatheter closure of CAF has emerged as a less invasive, safe and effective strategy. Echocardiography has important role in primary screening of patients and the follow-up after the treatments. Key words: Echocardiography; Coronary vessel anomalies; Coronary artery fistula

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Coronary artery fistulas (CAFs) are rare congenital or acquired abnormalities that have anomalous terminations of the coronary arteries. Although many patients with CAFs are asymptomatic, they can display various clinical features associated with ischemic heart disease or heart failure. Making an early diagnosis is important for the proper management and prevention of late symptoms and complications. Conventional coronary angiography and cardiac CT have been commonly performed to diagnose CAFs, but multi-detector computed tomography (MDCT) is now being widely applied for diagnosing cardiovascular anomalies, and the number of incidentally detected CAFs on MDCT has been increasing. Therefore, we have to be familiar with the image findings of CAFs, and especially the image findings of MDCT for making the correct diagnosis of CAFs. In this article, we illustrate the MDCT findings of various types of CAFs in adults and we review the pathophysiology and clinical features of CAFs.

Coronary Artery Fistulas: CT Findings

Coronary artery fistulas are anomalous terminations of the coronary arteries. Most often, these fistulas are incidentally identified in the adult and pediatric populations. Many patients are asymptomatic; however, an awareness of these fistulas is important because they have been associated with various clinical features, including chest pain or heart failure in young patients. Correct diagnosis of coronary artery fistulas is important, and early surgical correction is indicated because of the high prevalence of late symptoms and complications. Traditionally, conventional angiography has been used for the diagnosis of coronary anomalies. With more frequent use of 64-row multi-detector computed tomography (CT) in chest and cardiac imaging, the number of incidentally found coronary artery fistulas has been increasing. CT angiography and conventional angiography can have additive value in diagnosis of this cardiac anomaly. In every CT study of the heart, special attention should be paid to the courses and terminations of the coronary arteries to detect these potentially fatal anomalies.

Coronary Artery Fistula

Abstract: Coronary artery fistula is an unusual coronary artery anomaly. Cardiac catheterization with coronary angiography remains the gold standard for the diagnosis of coronary artery fistula, but the physiologic significance and the relationship of coronary artery fistulas to other structures may not be apparent when it is investigated with this technique. Cardiac multidetector computed tomography and stress myocardial perfusion SPECT can be used as adjuncts to coronary angiography for anatofunctional evaluation of this anomaly. We report the case of a 25-year-old male patient with effort angina in whom cardiac multidetector computed tomography and dipyridamole Tl-201 myocardial SPECT were shown to play an important role in the noninvasive evaluation of coronary artery fistula and provide a physiology-based decision-making assessment for determining the need for intervention of such an anomaly.

Coronary Fistula Anastomosing between Right Coronary Artery and Left Bronchial Artery Accompanied with Cystic Lung Disease

We report a case of 86-year-old woman with coronary artery fistula connecting the right coronary artery and left bronchial artery accompanied with cystic lung disease presenting with dyspnea and chest pain. Coronary angiography revealed that right coronary artery was anastomosed with the collaterals of left bronchial artery at the right hilum and tortuously ascended along the aortic arch and descended connecting with left pulmonary lobar artery at a certain site which is faintly opcified showing to and pro phasic movement. Chest CT scan shows the multicystic changes of the left lower lobe of the lung and hypertrophied bronchial artery of left lobar bronchus. Under the diagnosis of coronary artery fistula, hypertensive heart disease and multicystic lung disease, patient's symptoms and signs were improved by conservative treatment without surgical intervention. ( ( ( (Korean Circulation J 1999;29(4 :419-423

Diagnosis of Coronary Artery Fistula Confirmed by Intravenous Contrast Echocardiography

Congenital coronary fistulae are rare, but their accurate diagnosis is important because of several complications. We describe the first case of the echocardiographic diagnosis using an intravenous contrast agent.

Coronary Artery Fistula: An Abnormality Affecting All Age Groups

A coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber, great vessel, or other vascular structure. It is an infrequent but potentially important abnormality that can affect any age group. Most are congenital in origin, although other etiologies, in particular trauma, have been identified. Many are small and found incidentally during coronary arteriography, while others are identified as the cause of a continuous murmur, myocardial ischemia, congestive heart failure, or, rarely, bacterial endocarditis. The diagnosis should be considered in any patient presenting with a continuous murmur or in the setting of congestive heart failure, myocardial ischemia, or bacterial endocarditis without an obvious etiology. The pathophysiologic mechanisms resulting in symptoms include cardiac volume overload due to the shunting of blood and reduction of the myocardial blood supply due to "coronary steal." The diagnosis of coronary artery fistula may be suggested by the finding of a continuous murmur in a precordial location, which is atypical for patent ductus arteriosus. Two-dimensional echocardiography may demonstrate dilated coronary arteries, and pulse-wave and color-flow Doppler examinations can display turbulent flow in the suspected fistula and its receiving chamber or vessel. Angiography is generally needed to confirm the diagnosis and elucidate anatomic detail. The natural history of coronary artery fistula is variable, with long periods of stability in some patients and gradual progression of symptoms in others. Small fistulas detected incidentally at the time of angiography do not require immediate surgical correction, but careful follow-up is indicated because the potential for enlargement with physiologically important shunting exists and cannot readily be predicted. Spontaneous closure is uncommon. Surgical repair of the fistula is recommended for symptomatic patients and for some without symptoms because a quantitatively small shunt does not predict freedom from future symptoms or complications. Those selected for medical management must be followed closely.