Coronary Artery Fistulae

Reddy, Gautam; Davies, James E.; Holmes, David R.; Schaff, Hartzell V.; Singh, Satinder P.; Alli, Oluseun

doi:10.1161/circinterventions.115.003062

Cited by 52 publications

(95 citation statements)

References 11 publications

(8 reference statements)

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“…Selective invasive (ie, conventional) coronary angiography used to be the reference standard for assessment of CAFs. It enables precise visualization of the anatomy of the CAF, including fine vessels, with high temporal and spatial resolution and yields hemodynamic information (23). In addition, it facilitates the diagnosis and therapeutic embolization of CAFs.…”

Section: Diagnosis and Assessment Of Cafs With Cardiac Ct Angiographymentioning

confidence: 99%

“…Although a thrombus might be present in patients with large CAFs (Fig 11, Movie 4), the risk of thrombus is increased in elderly patients and those who have large distal CAFs and are not taking anticoagulation medication (73). ECG changes and arrhythmia also are frequently seen during and after transcatheter closure (23). In CAFs with a large fistulous tract, the coil or device can migrate (74).…”

Section: Postprocedural Complicationsmentioning

confidence: 99%

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Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. CAFs are rare, and most affected patients are asymptomatic. However, these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters. Although most CAFs are asymptomatic in young patients, symptoms and complications become more frequent with increasing age. CAFs are characterized by variable clinical manifestations that are based on the size, origin, and drainage site of the fistula. In symptomatic cases, surgical ligation or percutaneous transcatheter closure is often recommended. Although CAFs historically have been evaluated with conventional invasive angiography, electrocardiographically gated cardiac computed tomographic (CT) angiography has emerged as the noninvasive alternative modality of choice owing to the high spatial and temporal resolution and short acquisition time. Furthermore, three-dimensional volume-rendered CT angiograms facilitate accurate assessment of the complex anatomy of CAFs, including their origin, drainage site, and complexity and the number and size of fistulous tracts. Knowledge of these characteristics is crucial for therapeutic planning. Radiologists must be aware of the pathophysiology, clinical manifestations, and characteristic CT angiographic findings of CAFs; appropriate CT angiographic protocols for evaluation of various CAFs; and the role of CT angiography in preprocedural planning and follow-up. Online supplemental material is available for this article. RSNA, 2018.

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Section: Diagnosis and Assessment Of Cafs With Cardiac Ct Angiographymentioning

confidence: 99%

Section: Postprocedural Complicationsmentioning

confidence: 99%

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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“…Congenital coronary artery fistula (CAF) is defined as an abnormal connection between a coronary artery and a cardiac chamber or vein without an interposed capillary network. 1 These communications most frequently involve the right coronary artery (RCA) connected to the coronary sinus (CS) in 39%, the pulmonary artery in 26%, the right ventricle in 15%, the right atrium in 11%, and the superior vena cava in 4%. 2 If left untreated, high flow CAF can cause coronary artery aneurysm formation, heart failure, myocardial ischemia, infective endocarditis, atrial fibrillation, and vessel rupture.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Various transcatheter approaches to occlude CAF are associated with high procedural success, including using thrombogenic coils, vascular plugs, or covered stents [5][6][7] ; however, device embolization and vessel dissection can occur. 1,8,9 Herein, we describe a case of severe pseudoachalasia following attempted transcatheter closure of a giant CAF.…”

Section: Introductionmentioning

confidence: 99%

It hurts to swallow! Pseudoachalasia resulting from attempted transcatheter occlusion of a giant congenital coronary artery fistula

Deaño

Raval

2019

Cathet Cardio Intervent

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Congenital coronary artery fistula (CAF) is a rare anomaly that can cause heart failure and myocardial ischemia. In recent decades, transcatheter approaches to occlude CAF have emerged as minimally invasive alternatives to surgical ligation. Reported complications with transcatheter CAF occlusion include device embolization and dissection. We report the first case of attempted transcatheter occlusion of a giant CAF that resulted in severe pseudoachalasia.

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“…The coronary artery tends to undergo significant dilation proximal to the fistula, but this may not compensate for the steal. 2 Conventional coronary angiography is the gold standard for the assessment and diagnosis of CAFs. It only provides 2-dimensional images, which can be of limited value in large, tortuous, complex fistula of overlapping anatomy.…”

mentioning

confidence: 99%