Imaging of Coronary Artery Fistulas by Multidetector Computed Tomography: Is Multidetector Computed Tomography Sensitive?

Kacmaz, Fehmi; Ozbulbul, Nilgun Isiksalan; Alyan, Ömer; Maden, Orhan; Demir, Ahmet Duran; Atak, Ramazan; Şenen, Kubilay; Erbay, Ali Rıza; Balbay, Yücel; Ölçer, Tülay; İlkay, Erdoğan

doi:10.1002/clc.20286

Cited by 20 publications

(18 citation statements)

References 26 publications

(17 reference statements)

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“…1 The reported incidence of coronary-pulmonary artery fistulas constitutes 15∼20% of all coronary artery fistulas, and they are associated with aneurysmal dilatation in 19∼26% of cases. 3 Most of these fistulas arise from the right coronary artery or from the left anterior descending artery. The circumflex coronary artery is rarely involved.…”

Section: Discussionmentioning

confidence: 99%

“…1 Most adult patients are asymptomatic, but some patients present with exertional dyspnea, chest pain, syncope, and palpitation, presumably due to shunt-induced reduction in coronary blood flow. 1,3,4 With large fistulas, half of the patients develop complications, such as congestive heart failure, infective endocarditis, rupture of an aneurysm, or myocardial infarction. 5 The traditional diagnostic tool for coronary artery fistulas has been coronary angiography, but considerable progress has been made in the field of noninvasive coronary imaging.…”

Section: Discussionmentioning

confidence: 99%

“…2 New imaging modalities such as MDCT have been used to diagnose coronary artery fistulas with more accurate detail of the anatomy of the abnormal coronary artery, which facilitates the best management strategies, as described in this case. [2][3][4]6 Coronary computed tomography angiography (CTA) is a relatively new imaging modality that has been used for coronary artery imaging since 2000. 6 Previous systems had limited spatial and temporal resolution and were compromised by image-noise.…”

Section: Discussionmentioning

confidence: 99%

“…6 Because of its excellent spatial resolution and ability to demonstrate relationships between anatomical structures, coronary CTA may be the appropriate diagnostic modality for coronary artery fistulas, especially for fistulas coursing between the coronary artery and other vascular structures, and to detect fistula origin and drainage sites. [2][3][4]6 Coronary CTA would be an ideal noninvasive technique for imaging in patients with suspected coronary artery fistulas. 4,6 …”

Section: Discussionmentioning

confidence: 99%

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Coronary Arteriovenous Fistulas with Aneurysm

et al. 2010

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Coronary artery fistula with aneurysm is an infrequent vascular anomaly. Echocardiography and angiography have traditionally been used as diagnostic tools for coronary artery fistulas. However, new imaging modalities, such as multi-detector computed tomography (MDCT), can now be used to noninvasively determine the anatomy of an abnormal coronary artery accurately and to facilitate the formulation of appropriate management strategies. In this case, two huge coronary arteriovenous fistulas with aneurysmal changes were observed on 2D-echocardiography and coronary angiography performed on a 72-year-old female. The anatomy of the coronary arteriovenous fistula was then determined in detail by 64-slice MDCT angiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Coronary Arteriovenous Fistulas with Aneurysm

et al. 2010

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“…Multi-planar reformats and 3D reconstruction techniques such as volume rendering and surface shading enable exquisite demonstration of the anatomy of the fistulas, which is essential for surgical/interventional planning. CT scan has been shown to have high sensitivity of up to 87% compared to coronary angiography in the detection of coronary artery fistulas, with a lower sensitivity of 58% for fistulas draining in cardiac chambers [2] . Disadvantages of CT include the use of ionizing radiation and use of potentially nephrotoxic contrast media.…”

Section: Role Of Imagingmentioning

confidence: 99%

Unusual fistulas and connections in the cardiovascular system: A pictorial review

Ghandour

Rajiah

2014

WJR

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A fistula is an abnormal vascular connection leading to diversion of blood from a high resistance arterial circuit to low resistance venous circuit. Coronary artery fistulas are abnormal communications of the coronary artery with a chamber of the heart, or with any segment of systemic or pulmonary circulation, bypassing the myocardial capillaries. Other unusual fistulas include connection between aorta and the right atrium/superior vena cava, aorta and the inferior vena cava or between a coronary artery bypass graft and a cardiac vein. Abnormal connections also include origin of the coronary artery from the pulmonary artery. In this article, we review the imaging, particularly computed tomography and magnetic resonance imaging of unusual fistulas and connections involving the cardiovascular system, particularly the coronary arteries and the aorta. Key words: Coronary; Artery; FistulaCore tip: Computed tomography and magnetic resonance imaging are very useful imaging modalities in determining the type and demonstrating the anatomy of these fistulas, which is essential for surgical/interventional planning. Careful analysis in multiple planes and three-dimensional reconstruction is required for comprehensive evaluation of fistulas. Treatment depends on the symptoms and the anatomy.

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Unilateral and Multilateral Congenital Coronary‐Pulmonary Fistulas in Adults: Clinical Presentation, Diagnostic Modalities, and Management With a Brief Review of the Literature

Saïd

Nijhuis

Akker

et al. 2014

Clinical Cardiology

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Background: Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs. Hypothesis: Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography. Methods: We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments. Results: Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral.13 N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve. Conclusions: CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Imaging of Coronary Artery Fistulas by Multidetector Computed Tomography: Is Multidetector Computed Tomography Sensitive?

Cited by 20 publications

References 26 publications

Coronary Arteriovenous Fistulas with Aneurysm

Coronary Arteriovenous Fistulas with Aneurysm

Unusual fistulas and connections in the cardiovascular system: A pictorial review

Unilateral and Multilateral Congenital Coronary‐Pulmonary Fistulas in Adults: Clinical Presentation, Diagnostic Modalities, and Management With a Brief Review of the Literature

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