Successful percutaneous coronary intervention for multivessel stenosis complicated by a huge coronary artery fistula with the combined physiology and intracoronary anatomy techniques

Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine-13N-ammonia PET-CT

“…Ouyang et al[ 38 ] reported deferral of treatment of the fistula-related artery and tandem intermediate stenosis in a patient with a huge CAF originating from the LAD and draining into the PA based on the findings of FFR. In the case of an adult subject assessed by both FFR and intravascular ultrasound, PCI was performed for significant stenosis of the LAD, which was the fistula-related artery (LAD-PA), but the congenital fistula remained untouched due to the absence of myocardial ischemia[ 18 ]. In congenital CAFs, the steal phenomenon has been demonstrated by FFR[ 17 ].…”

“…CAFs are classified as anomalies of termination[ 7 ]. Several diagnostic modalities are available for the morphological and functional detection of CAFs, including physical examination (presence of a continuous murmur), non-invasive methods such as echocardiography[ 8 , 9 ], myocardial perfusion imaging (MPI)[ 10 , 11 ], CTCA[ 3 , 9 , 12 ] and cardiovascular magnetic resonance imaging (MRI)[ 13 ], invasive techniques such as right heart catheterization, CAG and fractional flow reserve (FFR)[ 1 , 14 - 18 ], and incidental detection during positron emission tomography computed tomography (PET-CT)[ 19 , 20 ]. Exercise and pharmacological PET-CT is commonly applied for the assessment of myocardial perfusion and ischemia, and for the diagnosis and risk stratification of ischemic coronary artery disease (CAD)[ 21 , 22 ].…”