Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography

Lee, Chul Min; Sang-Hwa, Song; Jeon, Seok Chol; Park, Choong-Ki; Choi, Yo Won; Lee, Youkyung

doi:10.1097/rct.0000000000000370

Cited by 19 publications

(19 citation statements)

References 17 publications

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“…Multiplanar reconstruction with 3D volume-rendered imaging could yield excellent anatomic information, including the origin, course, and drainage site of CPFs-even in cases of complex anomalies. Therefore, the coronary CTA are valuable tools for the cardiac physician to evaluate the origin, course, and drainage site of CPFs preoperatively and make the best management of fistulas (18,19).…”

Section: Discussionmentioning

confidence: 99%

The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience

et al. 2019

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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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Section: Discussionmentioning

confidence: 99%

The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience

et al. 2019

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“…CCTA with multiplanar reconstruction and volume-rendering technique images is more suitable to evaluate the morphologic characteristics and precise course of multiple fistulous tracts when present. CCTA also has the advantage of being noninvasive over conventional coronary angiography (14,(23)(24)(25)(26). CPAF may have a single or multiple feeding branches from coronary arteries, and mostly, a single drainage site at the left sinus of the MPA.…”

Section: Discussionmentioning

confidence: 99%

Congenital Coronary Artery–to–Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of “Double Trouble”

Kumar

2021

Radiology: Cardiothoracic Imaging

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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.

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“…The coronary-to-pulmonary artery fistula (CPAF) is the most common type of CAF found incidentally on CCTA, with a prevalence ranging from 0.17% to 0.68% (2345). Several studies have investigated the morphological characteristics of CPAF by using CCTA (5678).…”

Section: Introductionmentioning

confidence: 99%

Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies

et al. 2019

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ObjectiveTo 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 MethodsIn 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.ResultsThe 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.ConclusionMost 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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Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography

Cited by 19 publications

References 17 publications

The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience

The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience

Congenital Coronary Artery–to–Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of “Double Trouble”

Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies

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