Coronary artery fistulas morphology in coronary computed tomography angiography

Abstract

Background:The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. Materials and methods: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. Results: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. Conclusions: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Giant coronary artery fistula: A case report

“…They rarely drain into the CS and may frequently be associated with aneurysmal dilatation [2] . CAF prevalence based on computed tomographic angiography (CTA) is as high as 0.9%, higher than the previously reported prevalence of 0.002%-0.3% based on invasive angiography [3] . While CAFs have historically been evaluated by conventional invasive angiography, computed tomographic angiography (CTA) of the heart has emerged as a noninvasive method for quick diagnosis.…”

“…CTA is often used since it is a noninvasive examination for follow-up. While the results vary, residual leakage from CAF recanalization is present in 10% of transcatheter or surgically managed cases [3] . Therefore, we performed a CTA that showed the successful closure of the fistula without any relevant changes to the coronary arteries.…”

A Complicated Case Report of Coronary Artery Fistula

“…Cardiac contrast CT is a useful, noninvasive, and accurate imaging technique for detecting major coronary artery anomalies and may be performed as an alternative to coronary angiography in diagnosing ( 6 ). The CT scanning protocol assesses the anatomy of CAFs: origin, drainage site, and fistulous tracts ( 9 ). In a previous case, the fistula originated from the RCA, the most common origin site of CAFs, accounting for 50%–55% of cases ( 10 ).…”

“…In a previous case, the fistula originated from the RCA, the most common origin site of CAFs, accounting for 50%–55% of cases ( 10 ). The origin in the remaining cases is the two coronary arteries (the LAD and RCA), called coronary-to-bronchial artery fistulas ( 9 ). The prevalence of coronary-to-bronchial artery fistulas in CTA is estimated to be 0.61%.…”