open access

Vol 79, No 4 (2020)
Original article
Published online: 2019-12-04
Submitted: 2019-09-13
Accepted: 2019-10-22
Get Citation

Coronary artery fistulas morphology in coronary computed tomography angiography

E. Czekajska-Chehab, M. Skoczyński, P. Przybylski, G. Staśkiewicz, A. Tomaszewski, E. Siek, J. Kurzepa, M. Skoczyński, A. Drop
DOI: 10.5603/FM.a2019.0132
·
Pubmed: 31802472
·
Folia Morphol 2020;79(4):777-785.

open access

Vol 79, No 4 (2020)
ORIGINAL ARTICLES
Published online: 2019-12-04
Submitted: 2019-09-13
Accepted: 2019-10-22

Abstract

Background: The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula’s morphology and other cardiac functional findings and clinical data.

Materials and methods: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals.

Results: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients.

Conclusions: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Abstract

Background: The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula’s morphology and other cardiac functional findings and clinical data.

Materials and methods: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals.

Results: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients.

Conclusions: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Get Citation

Keywords

coronary, fistula, coronary computed tomography angiography, angiography, classification

About this article
Title

Coronary artery fistulas morphology in coronary computed tomography angiography

Journal

Folia Morphologica

Issue

Vol 79, No 4 (2020)

Article type

Original article

Pages

777-785

Published online

2019-12-04

DOI

10.5603/FM.a2019.0132

Pubmed

31802472

Bibliographic record

Folia Morphol 2020;79(4):777-785.

Keywords

coronary
fistula
coronary computed tomography angiography
angiography
classification

Authors

E. Czekajska-Chehab
M. Skoczyński
P. Przybylski
G. Staśkiewicz
A. Tomaszewski
E. Siek
J. Kurzepa
M. Skoczyński
A. Drop

References (29)
  1. Albeyoglu S, Aldag M, Ciloglu U, et al. Coronary arteriovenous fistulas in adult patients: surgical management and outcomes. Braz J Cardiovasc Surg. 2017; 32(1): 15–21.
  2. Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989; 117(2): 418–434.
  3. Buccheri D, Chirco PR, Geraci S, et al. Coronary artery fistulae: anatomy, diagnosis and management strategies. Heart Lung Circ. 2018; 27(8): 940–951.
  4. Carrel T, Tkebuchava T, Jenni R, et al. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. Cardiology. 1996; 87(4): 325–330.
  5. Cebi N, Schulze-Waltrup N, Frömke J, et al. Congenital coronary artery fistulas in adults: concomitant pathologies and treatment. Int J Cardiovasc Imaging. 2008; 24(4): 349–355.
  6. Chiu SN, Wu MH, Lin MT, et al. Acquired coronary artery fistula after open heart surgery for congenital heart disease. Int J Cardiol. 2005; 103(2): 187–192.
  7. Dodge-Khatami A, Mavroudis C, Backer CL. Congenital heart surgery nomenclature and database project: anomalies of the coronary arteries. Ann Thorac Surg. 2000; 69(4 Suppl): S270–S297.
  8. Gautam R, James ED, David RH, et al. Coronary artery fistulae. Circulation: Cardiovasc Interv. 2015; 8(11).
  9. Krause W. Uber den ursprung einer accessorischen a. coronaria aus der a. pulmonalis. Z Ratl Med. 1865; 24: 225–227.
  10. Li A, Peng Z, Zhang C. Comparison of echocardiography and 64-multislice spiral computed tomography for the diagnosis of pediatric congenital heart disease. Med Sci Monit. 2017; 23: 2258–2266.
  11. Lim JJ, Jung JIm, Lee BY, et al. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol. 2014; 203(3): W237–W243.
  12. Mangukia CV. Coronary artery fistula. Ann Thorac Surg. 2012; 93(6): 2084–2092.
  13. Ogden J. Congenital anomalies of the coronary arteries. Am J Cardiol. 1970; 25(4): 474–479.
  14. Pelech AN. Coronary Artery Fistula (2008). http://www.emedicine.com/ped/topic2505.html (Last accessed on 2008 Mar 21).
  15. Podolec J, Wiewiórka Ł, Siudak Z, et al. Presence and characteristics of coronary artery fistulas among patients undergoing coronary angiography. Kardiol Pol. 2019; 77(11): 1034–1039.
  16. Qureshi R, Kao L, Gupta RP. Coronary artery fistula with associated Takotsubo cardiomyopathy: a case report. J Med Case Rep. 2018; 12(1): 86.
  17. Saboo SS, Juan YH, Khandelwal A, et al. MDCT of congenital coronary artery fistulas. AJR Am J Roentgenol. 2014; 203(3): W244–W252.
  18. Said SAM, Oortman RM, Hofstra JH, et al. Coronary artery-bronchial artery fistulas: report of two Dutch cases with a review of the literature. Neth Heart J. 2014; 22(4): 139–147.
  19. Sakakibara S, Yokoyama M, Takao A, et al. Coronary arteriovenous fistula. Am Heart J. 1966; 72(3): 307–314.
  20. Salah AM. Solitary coronary artery fistulas: a congenital anomaly in children and adults. A contemporary review. World J Cardiol. 1966; 2(1): 6–12.
  21. Salah SA, Schiphorst RH, Derksen R, et al. Coronary-cameral fistulas in adults: Acquired types (second of two parts). World J Cardiol. 2013; 5(12): 484–494.
  22. Schumacher G, Roithmaier A, Lorenz HP, et al. Congenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects. Thorac Cardiovasc Surg. 1997; 45(6): 287–294.
  23. Shi Ke, Gao HL, Yang ZG, et al. Preoperative evaluation of coronary artery fistula using dual-source computed tomography. Int J Cardiol. 2017; 228: 80–85.
  24. Sun JP, Yang L, Zhao Z, et al. A rare right coronary artery-left ventricular fistula with giant coronary artery and aneurysm. Eur Heart J Cardiovasc Imaging. 2019; 20(5): 604.
  25. Uzu K, Otake H, Choi G, et al. Lumen boundaries extracted from coronary computed tomography angiography on computed fractional flow reserve (FFRCT): validation with optical coherence tomography. EuroIntervention. 2019; 14(15): e1609–e1618.
  26. Villa AD, Sammut E, Nair A, et al. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol. 2016; 8(6): 537–555.
  27. Wen B, Yang J, Jiao Z, et al. Right coronary artery fistula misdiagnosed as right atrial cardiac myxoma: A case report. Oncol Lett. 2016; 11(6): 3715–3718.
  28. Xu H, Zhu Y, Zhu X, et al. Anomalous coronary arteries: depiction at dual-source computed tomographic coronary angiography. J Thorac Cardiovasc Surg. 2012; 143(6): 1286–1291.
  29. 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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl