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Giovannico L, Santeramo V, Moschou M, Di Bari N, Bottio T. Coronary artery-to-pulmonary artery fistula: a rare congenital heart disease from cardiovascular imaging to the intraoperative findings. J Cardiovasc Med (Hagerstown) 2024; 25:342-343. [PMID: 38407850 DOI: 10.2459/jcm.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
| | | | - Maria Moschou
- School of Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
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Ozenbas C, Sukun A. Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction. Cureus 2024; 16:e58627. [PMID: 38770477 PMCID: PMC11103546 DOI: 10.7759/cureus.58627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.
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Affiliation(s)
- Cemre Ozenbas
- Radiology, Tınaztepe University Private Buca Hospital, Izmir, TUR
| | - Abdullah Sukun
- Radiology, Başkent University Alanya Application and Research Center, Antalya, TUR
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Yılancıoğlu RY, Turan OE, Barış MM, Özcan EE. Fluoroscopy integration module guides successful ablation in atrial fibrillation with coronary-pulmonary artery fistula. Hellenic J Cardiol 2024:S1109-9666(24)00070-8. [PMID: 38494074 DOI: 10.1016/j.hjc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Reşit Yiğit Yılancıoğlu
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye.
| | - Oğuzhan Ekrem Turan
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye
| | - Mahmut Mustafa Barış
- Faculty of Medicine, Department of Radiology, Dokuz Eylul University, Izmir 35220, Turkiye
| | - Emin Evren Özcan
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye
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Hirofuji A, Furugen A, Kamada T, Yamazaki K, Kamiya H, Doi H. Giant Coronary Aneurysm with Coronary-Pulmonary Artery Fistula in a Jehovah's Witness. Thorac Cardiovasc Surg Rep 2023; 12:e1-e3. [PMID: 36741974 PMCID: PMC9897952 DOI: 10.1055/s-0042-1757877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/12/2022] [Indexed: 02/05/2023] Open
Abstract
With an incidence of 3 in 100 million, giant coronary artery aneurysm (CAA) with coronary artery fistula (CAF) is a very rare condition. To prevent rupture, giant CAA with CAF should be swiftly treated. We present a Jehovah's Witness patient with giant CAA and coronary-pulmonary artery fistula. We resected the giant CAA in one piece, while ligating the CAF, without allogeneic blood transfusion. Due to rarity of these conditions, many thoracic surgeons lack direct experience in its surgical procedures. Herein, we share footage of this surgery as an example of how to safely resect CAA with minimal bleeding.
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Affiliation(s)
- Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan,Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan,Address for correspondence Aina Hirofuji, MD Department of Cardiac Surgery, Asahikawa Medical UniversityMidorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan; Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, 1-30 South 27 West 13, Chuo-ku, Sapporo 064-8622Japan
| | - Azusa Furugen
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
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Kamal MM, Sundardas R, Sohail AA, Usman M, Iqbal S, Tipu FA, Fatimi SH. Coronary artery to pulmonary artery fistula: Catheter or scalpel? A case report. Int J Surg Case Rep 2022; 97:107416. [PMID: 35870213 PMCID: PMC9403205 DOI: 10.1016/j.ijscr.2022.107416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Coronary artery fistula (CAF) is an abnormal connection between coronary artery and a major vessel or cardiac chamber with left to right shunt having an incidence of 0.002 % in recent literature. Fistulous communication of coronary artery with pulmonary artery (PA) is a rare subtype and comprises of about 17 % of all the CAF cases. CASE PRESENTATION We report a case of a middle-aged gentleman, known case of asymptomatic CAF for the last 20 years. He presented to us with 6 months history of chest pain on exertion. On coronory angiogram he was diagnosed to have a preexisting CAF of proximal LAD to main PA and severe coronary artery disease in left anterior descending coronary artery (LAD). He was managed surgically and underwent ligation of the fistula along with coronary artery bypass grafting (CABG). CLINICAL DISCUSSION Management of CAF is medical, percutaneous or open-heart surgery. Due to rarity of the disease no international guidelines exists and treatment is controversial. Complications of CAF include endocarditis, early atherosclerosis, rupture, hemopericardium, pulmonary hypertension and myocardial ischemia, hence early correction is warranted. Our case emphasizes on the natural course of this rare disease and how to change management plan accordingly in the better interest of patient. CONCLUSION Our case presents the natural course and management of a rare congenital cardiac disease. Surgery was chosen as an appropriate option due to CAD involving proximal LAD and concomitant coronary artery to PA fistula.
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Affiliation(s)
- Mian Mustafa Kamal
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan.
| | - Rita Sundardas
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Abdul Ahad Sohail
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan
| | - Majid Usman
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan.
| | - Sara Iqbal
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan.
| | - Fateh Ali Tipu
- Department of Cardiology, Aga Khan University Hospital Karachi, Pakistan.
| | - Saulat Hasnain Fatimi
- Department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, Pakistan.
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Cai R, Ma X, Zhao X, Xu J, Zhu L, Ku L. CTA analysis of 482 cases of coronary artery fistula: A large-scale imaging study. J Card Surg 2022; 37:2172-2181. [PMID: 35508600 DOI: 10.1111/jocs.16500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types. MATERIALS AND METHODS From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow-up DSCT images were also evaluated. Analyze the difference between the coronary-pulmonary artery fistula (CPAFs) group (380) and the coronary-cameral fistula (CCF) group (99). RESULTS Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated. CONCLUSIONS Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.
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Affiliation(s)
- Renhui Cai
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xiaojing Ma
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Juan Xu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Li Zhu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Leizhi Ku
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
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Hang K, Zhao G, Su W, Bao G, Zhao Q, Jiao Z, Tian Z, Zhang H, Nie L, Luo R, Li L, Huang M, Shi L, Li S. Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1434. [PMID: 34733986 PMCID: PMC8506747 DOI: 10.21037/atm-21-4404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022]
Abstract
Background To analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA). Methods This was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion. Results A total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without. The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees. Conclusions The 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.
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Affiliation(s)
- Kaibing Hang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Guoli Zhao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Weiwei Su
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Guangjin Bao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Qi Zhao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Zizhen Jiao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Zhanqi Tian
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Hui Zhang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lin Nie
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Rui Luo
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lifang Li
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Min Huang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lijing Shi
- Department of Radiology, Sixth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Shuping Li
- Naval Medical Center of People's Liberation Army, Shanghai, China
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Wang D, Hu C. A rare case of Vieussens' arterial ring with multiple pulmonary fistulas and aneurysms. Quant Imaging Med Surg 2021; 11:4504-4507. [PMID: 34604004 DOI: 10.21037/qims-20-1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Duoyao Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Radiology, Lianyungang Oriental Hospital, Lianyungang, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kumar P. Congenital Coronary Artery-to-Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of "Double Trouble". Radiol Cardiothorac Imaging 2021; 3:e210003. [PMID: 34498004 PMCID: PMC8415169 DOI: 10.1148/ryct.2021210003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Congenital coronary artery fistula is a rare coronary anomaly. Its clinical significance focuses mainly on the mechanism of coronary steal phenomenon. A combination of left main (LM) coronary artery-to-main pulmonary artery (MPA) fistula with anomalous origin of right coronary artery from the pulmonary artery (ARCAPA) was encountered in a 3-month-old infant who presented with tachypnea. Evaluation with echocardiography and CT confirmed the diagnosis. The patient underwent surgical ligation of LM-to-MPA fistula with direct reimplantation of ARCAPA to aortic root. Keywords: Pediatrics, CT, CT-Angiography, Echocardiography © RSNA, 2021.
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Kim H, Beck KS, Choe YH, Jung JI. Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies. Korean J Radiol 2020; 20:1491-1497. [PMID: 31606954 PMCID: PMC6791815 DOI: 10.3348/kjr.2019.0331] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. MATERIALS AND METHODS In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. RESULTS The median age of the study population was 63.0 years (range, 57.0-72.0 years), and the median FU period was 5.72 years (range, 4.08-6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. CONCLUSION Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.
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Affiliation(s)
- Hokun Kim
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea.
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Li N, Zhao P, Wu D, Liang C. Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 cases. Br J Radiol 2019; 93:20190523. [PMID: 31638419 DOI: 10.1259/bjr.20190523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronary artery fistulas (CAFs) are abnormal connections of the coronary arteries that bypass the myocardial capillary bed and terminate into chambers of the heart or major blood vessels. CAFs are rare, and most of them are congenital. Because CAFs can be asymptomatic and detected incidentally, the true incidence is difficult to evaluate. CAFs usually have various and complicated image features, and the clinical symptoms mainly depend on the size, origin and drainage site of the fistulas. Thus, accurate imaging assessment of these characteristics is crucial for therapeutic planning and post-operative evaluation. Due to the high temporal and spatial resolution, coronary CT angiography has recently become more widely used in cardiovascular disease diagnosis, and more asymptomatic CAFs are accidentally found. Furthermore, with multiplanar reconstruction images, some complicated and subtle structures can be displayed more accurately. In this article, we reviewed the imaging features of CAFs on coronary CT angiography, mainly focusing on the pre- and post-operative anatomy displaying of these abnormalities.
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Affiliation(s)
- Ning Li
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
| | - Peng Zhao
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Dawei Wu
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
| | - Changhu Liang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
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Xu H, Wang D, Li W, Ma L, Guo X, Ni Y. Three-dimensional visualization technology in coronary-pulmonary artery fistula. J Card Surg 2019; 34:1094-1096. [PMID: 31376221 DOI: 10.1111/jocs.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Hongfei Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongfei Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiming Ni
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Liu X, Zhang L, Qi Z, Fan M, Ge J. The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience. J Thorac Dis 2019; 11:2808-2815. [PMID: 31463109 DOI: 10.21037/jtd.2019.06.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Due to the low prevalence, the optimal treatment strategy of coronary-pulmonary artery fistula (CPF) remains unclear, and there are no established therapeutic guidelines available. The purpose of this study is to investigate the characteristics of CPF, and evaluate the effectivity of trans-catheter closure (TCC) for CPFs. Methods Patients with CPFs were retrospectively reviewed and enrolled according to the inclusion criteria. The data of clinical manifestations, physical signs, electrocardiogram (ECG), echocardiography, coronary CTA, coronary angiography and intervention procedure were collected. The telephone follow-up was conducted to evaluate the prognosis. Results The most common presenting complaint was dyspnea (n=21, 48.84%), followed by chest pain (n=10, 23.36%), palpitation (n=6, 13.95%), dizziness (n=3, 6.98%), and syncope (n=3, 6.98%). Most patients were coupled with single fistula (n=17, 39.53%) or two fistulas (n=23, 53.49%). Thirty fistulas (41.67%) involved the left anterior descending (LAD) artery, 28 fistulas (38.89%) involved the right coronary, 9 fistulas (12.50%) involved the left main trunk, and 5 fistulas (6.94%) involved the circumflex branch. Most of the fistulous tracts originated within the proximal one-third of the coronary arteries, only 6 fistulous tracts (8.33%) originated from the distal segment of the coronary arteries. The size of fistulas arranged from 1 mm to 8 mm, with an average of 3.45 mm. Thirty-five patients (81.40%) with 63 fistulas (87.50%) were successfully treated by percutaneous transcatheter closure. Thirty-eight patients accepted the 6-month follow-up, 36 patients (94.74%) were asymptomatic and 2 patients (5.26%) with palpitation. In conclusion, patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs. Conclusions patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs.
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Affiliation(s)
- Xin Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Zhiyong Qi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Mengkang Fan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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15
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Rowe SP, Fishman EK. Coronary artery to pulmonary artery fistula visualized with 3D cinematic rendering. J Cardiovasc Comput Tomogr 2018; 12:166-167. [DOI: 10.1016/j.jcct.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 09/30/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
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Lee SK, Jung JI, O JH, Kim HW, Youn HJ. Coronary-to-pulmonary artery fistula in adults: Evaluation with thallium-201 myocardial perfusion SPECT. PLoS One 2017; 12:e0189269. [PMID: 29216309 PMCID: PMC5720796 DOI: 10.1371/journal.pone.0189269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Abstract
Objectives With the increasing use of multi-detector CT, the number of detected cases with coronary-to-pulmonary artery fistula (CPAF) has increased. Several previous studies reported severe cases of angina, but no appropriate tests to evaluate myocardial perfusion for patients with CPAF have been established. We evaluated the hemodynamic characteristics of CPAF using thallium-201 (Tl-201) single photon emission computed tomography (SPECT). Materials and methods Tl-201 SPECT was performed in 17 patients with CPAF, but without evidence of coronary artery disease on coronary computed tomography angiography (CCTA) (age, 58.5±13.3 years; 8 men). Quantitative analysis of scintigraphic data was performed. Additionally, perfusion abnormalities were compared with CCTA findings. Medical records were obtained to define clinical data, diagnostic findings, symptoms, management, follow-up data, and major adverse cardiac events (MACE). Results Six patients (35.2%) showed perfusion abnormalities on SPECT studies and could be classified as follows: 3 patients, no reversible ischemia (3/17, 17.6%); 1 patient, mild ischemia (1/17, 5.8%); and 2 patients, moderate ischemia (2/17, 11.7%). During the follow-up, ten patients (58.8%) improved under medical management and 5 patients (29.4%) underwent surgical ligation for CPAF with symptomatic improvement in 4 patients. Seven patients performed follow-up myocardial perfusion SPECT, and symptomatic improvement correlated well with scintigraphic perfusion improvement in 6 patients No MACE was observed. Clinical significance Tl-201 myocardial perfusion SPECT might be useful for determining the hemodynamic status and for risk stratification in patients with CPAF.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hyun O
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Youn
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Thind GS, Agrawal Y, Kalavakunta JK, Lapenna R. A case of congenital coronary-pulmonary fistulas presenting as spontaneous mediastinal haemorrhage. BMJ Case Rep 2017; 2017:bcr-2017-221282. [PMID: 28724599 DOI: 10.1136/bcr-2017-221282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coronary artery fistulas are rare anomalous vascular connections between coronary arteries and a cardiac chamber or a central vessel, without an intervening capillary bed. Coronary-pulmonary fistulas are a distinct subset of coronary artery fistulas. We present the case of a previously healthy 63-year-old-man who presented with chest pain and was found to have mediastinal haemorrhage. Upon further investigations, he was found to have multiple coronary-pulmonary fistulas with pseudoaneurysm formation in three of the fistulas. Two of these pseudoaneurysms showed inflammatory changes indicative of recent bleed. These were determined to be the source of the mediastinal bleeding and patient’s initial presentation. The patient was managed medically after obtaining multiple expert opinions from various institutions.
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Affiliation(s)
- Guramrinder Singh Thind
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Yashwant Agrawal
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | | | - Robert Lapenna
- Borgess Medical Center/Michigan State University, Kalamazoo, Michigan, USA
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