Multi-Detector CT Coronary Angiographic Findings of Coronary-to-Pulmonary Artery Fistula

Abstract

Purpose: To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). Materials and Methods:We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Results: Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. Conclusion: MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning.

Fistula from right and left coronary arteries to pulmonary artery: Coronary CT angiography and coronary angiography findings

“…Identifying the drainage site of a CPAF is clinically more important for surgical closure than identifying its origin. In one study, CPAFs in most patients (54 out of 55, 98%) drained into a single site at the left sinus of the main pulmonary artery, consistent with the results of other studies [6] . In our patient, CCTA showed very unusual imaging features including 2 origins of feeding arteries and multiple fistulous drainage sites in both the left and right sinuses of the main pulmonary artery.…”

“…These enlargements normally involute, except for the 2 from the right and left aortic sinuses. CPAF may result from persistence of one or more of the pulmonary arterial enlargements, hence the term accessory coronary artery [6 , 7] . On the other hand, acquired cases are associated with complications developed after cardiac operation, secondary to percutaneous intervention, endomyocardial biopsy, chest trauma, and myocardial infarction [3 , 7 , 8] .…”

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

“…The exact prevalence of CAF is unknown and has been reported to be approximately 0.1%-0.2% at invasive coronary angiography and as high as 0.9% at CCTA (10)(11)(12)(13)(14). This discrepancy can be explained by the limitations of invasive coronary angiography and benefits of CCTA.…”

“…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.…”

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

“…Further, the prevalence of CAF was reported to be up to 0.9% when it was detected as an incidental finding during coronary computed tomography angiography (CCTA), which has been widely used in recent years (23). 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).…”