Retrospective Evaluation Of Coronary Artery Fistulas With CT Angiography

Year 2024, Volume: 31 Issue: 2, 143 - 149, 29.06.2024

Zeynep Ayvat Öcal , Akın Çinkooğlu , Selen Bayraktaroğlu , Naim Ceylan

https://doi.org/10.17343/sdutfd.1380239

Abstract

Objective: Coronary artery fistula is the termination of the coronary artery branch in the cardiac chamber or pulmonary vein. In this study, we aimed to evaluate the type, origin, termination, and accompanying anomalies, if any, of coronary artery fistulas in patients who underwent coronary CTA in our clinic.
Material and Method: Coronary CTA examinations were performed on a 128-slice CT scanner. Images were evaluated using MPR, MIP and 3D VR reconstructions on the workstation. CTA image interpretation was performed independently by two radiologists with 15 and 2 years of experience in coronary CTA. In case of disagreement, a third radiologist was consulted.
Results: Coronary artery fistulas were found in 8 female and 6 male patients aged between 10 and 71 years, with a mean age of 39.07 years. Of the 15 fistula, 6 were coronacameral fistula, 7 were coronopulmonary fistula, 1 was between the left circumflex artery and the conal branch of the right coronary artery, and 1 was between the pulmonary trunk and the descending aorta. One patient was treated with coil placement in the interventional radiology department, while three cases were treated surgically. The other cases were followed up by the relevant clinics.
Conclusion: Coronary CT angiography provides three-dimensional images of the origin, course and termination of the fistula and is an important tool in guiding the patient's treatment plan.

Keywords

CORONARY ARTERY FISTULAS, CT ANGIOGRAPHY, Coronary Angiography

BT Anjiyografi ile Koroner Arter Fistüllerinin Retrospektif Değerlendirilmesi

Abstract

RETROSPECTIVE EVALUATION OF CORONARY ARTERY FISTULAS WITH CT ANGIOGRAPHY

OBJECTIVE
Coronary artery fistula is the termination of the coronary artery branch in the cardiac chamber or pulmonary vein. In this study, we aimed to evaluate the type, origin, termination, and accompanying anomalies, if any, of coronary artery fistulas in patients who underwent coronary CTA in our clinic.

METHODS
Coronary CTA examination of the patients was performed and images were evaluated on the workstation using MPR, curved MPR, MIP, and VR 3D postprocessing. Interpretation of CTA images of the patients was performed independently by two radiologists with 15 years and 2 years of experience in coronary CTA. In case of disagreement on interpretation, consensus was reached with a third radiologist.

RESULTS
Coronary artery fistula was diagnosed aged between 10 and 71. Of the 15 fistulas, 6 were coronacamaral fistula, 7 were corona-pulmonary fistulas, 1 was corona-coronary fistula between the left circumflex artery and the conal branch of the right coronary artery and 1 was between the pulmonary trunk and the descending aorta. While one patient was treated by placing a coil in the interventional radiology department, the surgical operation was performed in three cases. Other cases were followed up by the relevant clinics.

CONCLUSION
Cardiac CTA with 3D reconstruction is a very important modality for accurately assessing the complex anatomy of coronary artery fistulas and guiding treatment plans.

Keywords

koroner arter fistül, koroner bt anjiografi, katater anjiografi

Ethical Statement

This study was carried out retrospectively and Ethics Committee approval was obtained from Ege University with a letter dated 28.03.2023 .

Supporting Institution

There is no institutional and financial support for this research

Thanks

There is no conflict of interest between the authors, thanks to my coworkers

References

• 1. Boudoulas KD, Boudoulas H. Coronary Artery Fistulas. Cardiology 2017;136(2):90-92.
• 2. Verdini D, Vargas D, Kuo A, Ghoshhajra B, Kim P, Murillo H, et al. Coronary-Pulmonary Artery Fistulas: A Systematic Review. J Thorac Imaging 2016;31(6):380-390.
• 3. Lee CM, Song SY, Jeon SC, Park CK, Choi YW, Lee Y. Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography. J Comput Assist Tomogr 2016;40(3):398-401.
• 4. Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and Types of Coronary Artery Fistulas Detected with Coronary CT Angiography. AJR Am J Roentgenol 2014;203(3): W237-43.
• 5. Sakata N, Minematsu N, Morishige N, Tashiro T, Imanaga Y. Histopathologic Characteristics of a Coronary-pulmonary Artery Fistula with a Coronary Artery Aneurysm. Ann Vasc Dis 2011;4(1):43-6.
• 6. Saboo SS, Juan YH, Khandelwal A, et al. MDCT of Congenital Coronary Artery Fistulas. AJR Am J Roentgenol 2014;203(3):244-52.
• 7. Zhou K, Kong L, Wang Y, et al. Coronary Artery Fistula in Adults: Evaluation with Dual-Source CT Coronary Angiography. Br J Radiol 2015;88(1049):20140754.
• 8. Baş S. Coronary Artery Fistulas in Adults: Evaluation with Coronary CT Angiography. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 2021;8(2):104-108.
• 9. Li N, Zhao P, Wu D, Liang C. Coronary Artery Fistulas Detected with Coronary CT Angiography: a Pictorial Review of 73 Cases. Br J Radiol 2020;93:20190523
• 10. Zenooz NA, Habibi R, Mammen L, Finn JP, Gil- keson RC. Coronary Artery Fistulas: CT Findings. RadioGraphics 2009;29:781–789.
• 11. Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics 2018;38(3):688-703.
• 12. Navid A. Zenooz, Reza Habibi, Leena Mammen, J. Paul Finn, and Robert C. Gilkeson. Coronary Artery Fistulas: CT Findings, RadioGraphics 2009;29:3,781-789.
• 13. Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistula Anatomy, Diagnosis and Management Strategies. Heart Lung Circ 2018;27(8):940-951.
• 14. Christmann M, Hoop R, Dave H, et al. Closure of Coronary Artery Fistula in Childhood Treatment Techniques and Long-Term Follow-Up. Clin Res Cardiol 2017;106:211–218.