Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

Noda, Yoshiki; Matsutera, Ryo; Yasuoka, Yoshinori; Abe, Haruhiko; Adachi, Hidenori; Hattori, Satoshi; Araki, Ryo; Imanaka, Tadayuki; Kosugi, Motohiro; Sasaki, Tatsuya

doi:10.4061/2010/861068

Cited by 7 publications

(6 citation statements)

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“…Approximately, 40% were managed conservatively, 27% has coil embolization, 27% had surgical treatment, and 13% had catheter-mediated occlusion of the fistula. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Dodge-Khatami et al 17 have classified CAFs as follows:…”

Section: Discussionmentioning

confidence: 99%

“…8 A newer technology, like multidetector row computed tomography, is a noninvasive tool recommended by the American Heart Association Committee to evaluate suspected or known CAF. 12,13 Transthoracic echocardiography with color flow imaging can demonstrate a CAF noninvasively. 13 Magnetic resonance angiography can also be used to determine the anatomic course of CAF.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Transthoracic echocardiography with color flow imaging can demonstrate a CAF noninvasively. 13 Magnetic resonance angiography can also be used to determine the anatomic course of CAF. 7 No consensus exists on the optimal management of CAFs.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

2013

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An 86-year-old woman with a history of hypertension, diabetes, coronary artery disease, and arrhythmias was presented to the emergency department with a productive malaise, fever, worsening shortness of breath, and diaphoresis. The patient was normotensive, tachycardic, hypoxic, with regular heart sounds without associated murmur with clinical evidence of congestive heart failure (distension of jugular veins and bilateral basal lung crackles).A 12-lead electrocardiogram revealed sinus tachycardia with a heart rate of 124 beats per minute with new T-wave inversions in lead aVL, and ST depressions in leads V5 and V6. Beta natriuretic peptide was 546 pg/mL. Chest X-ray demonstrated diffuse pulmonary edema.The patient initially was placed on a nitroglycerin drip; however, her blood pressure dropped substantially, and therefore, this medication had to be discontinued. The patient also received nebulizer treatments and oxygen that resulted in improvement of her clinical condition. She was admitted for management of congestive heart failure and pneumonia. She was started on medical treatment of pneumonia (Levofloxacin, Sagent Pharmaceuticals, Schaumburg, IL) and congestive heart failure (furosemide, β-blockers, and angiotensin-converting enzyme inhibitor). Echocardiogram demonstrated multiple wall motion abnormalities, ejection fraction of 30 to 35% with almost global hypokinesis with akinetic areas in the mid septal, basal inferior, and inferoseptal areas, two-fourth diastolic dysfunction, mild mitral regurgitation, and mild pulmonary hypertension. Cardiac catheterization revealed severe triple vessel disease with left dominant system, and aneurysmal left main disease with a critical lesion of proximal circumflex with ulcerated plaque that was subsequently stented. The patient also had a 70% proximal left anterior descending (LAD) lesion and coronary artery to pulmonary artery fistulas originating from the left main coronary artery (►Fig. 1) and right coronary artery (►Fig. 2) with small shunt flow. DiscussionCoronary artery fistula (CAF) is an abnormal communication between a coronary and a heart chamber or any segment of the systemic or pulmonary circulation. These are often grouped together as coronary arterial-venous fistulas. A coronary artery connection to the pulmonary Keywords ► congestive heart failure ► fistulas ► cardiac catheterization ► angiography ► coronary arteries AbstractAn 86-year-old woman with history of hypertension, diabetes, hyperlipidemia, and coronary artery disease was admitted with new-onset congestive heart failure and pneumonia. She underwent coronary angiography after suffering a non-ST elevation myocardial infarction. There was severe coronary artery disease in addition to coronary artery-pulmonary fistulas involving proximal right coronary artery and a branch of left main coronary artery. Coronary artery fistula (CAF) is an abnormal communication between one or more coronary arteries and great vessels or a cardiac chamber. We reviewed 15 cases of CAFs published in PubMed and studied th...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

2013

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“…For the morphological, anatomical visualization, and functional assessment of CAFs, different diagnostic modalities separately or combined were applied to confirm the presence of unilateral [12,13,[59][60][61] , bilateral [16,19,30,48,62] , or multilateral [6,21,63] CAFs. In the reviewed group, the cornerstone in establishing the diagnosis was conventional coronary angiography (CAG) (97%) and echocardiography (68%).…”

Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

“…With these advanced diagnostic techniques many unilateral [10][11][12][13][14][15] , bilateral [16][17][18][19][20] and multilateral [21] fistulas have been diagnosed. Many reports from various parts of the world recording congenital CAFs in adults have been published during the last decade [22][23][24][25][26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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AIM:To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS:A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multislice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION:Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

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

Lee

Sang-Hwa

Jeon³

et al. 2016

Journal of Computer Assisted Tomography

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Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

Cited by 7 publications

References 10 publications

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

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

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