A Coronary Artery Fistula Successfully Closed With the Precise Guidance of Three-Dimensional Echocardiography

Esper, Stephen A.; Fink, Ryan J.; Rhodes, John F.; Harrison, J. Kevin; Mackensen, G. Burkhard

doi:10.1053/j.jvca.2013.11.016

Cited by 6 publications

(3 citation statements)

References 2 publications

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“…Echocardiographic imaging of fistulae can be challenging; 2D TTE and 2D TEE can give information about origin and distal exit points of fistula, as well as volume overload and severity of shunt ( 38 ), but they may have limitations in tracing its course and precisely define the site of drainage ( 39 ). Although limited, some experiences of percutaneous procedures under 3D TEE have been reported, highlighting how 3DE can add additional values in these complex scenarios ( 40 , 41 ).…”

Section: Echo-guidance In the Cath-lab: Clinical Applicationsmentioning

confidence: 99%

Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

et al. 2022

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Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.

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Section: Echo-guidance In the Cath-lab: Clinical Applicationsmentioning

confidence: 99%

Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

et al. 2022

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“…24 If the fistula is sufficiently delineated, 3-dimensional (D) techniques have shown to be useful in visualizing the anatomy and has been reported to aid in guidance in CAF closure, although has yet to be widely adopted for this purpose, and its future role is unclear. 25,26 Lastly, echocardiography allows for assessment of cardiac chambers' structure and function, which provides complimentary information on the hemodynamic significance of the fistula and allows screening for coexisting cardiac conditions. 27 However, given the typical field-of-view limitations of echocardiography, further imaging is typically pursued to better evaluate the course and nature of the fistula.…”

Section: Echocardiographymentioning

confidence: 99%

Coronary Artery Fistulas

Kalisz

Sanders

Avery

et al. 2020

Journal of Thoracic Imaging

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Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.

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“…More accurate imaging modalities, such as two- and three-dimensional transthoracic and transesophageal echocardiograms (2D and 3D TTE and TEE), Doppler echocardiography, enhanced chest computed tomography (CT), and coronary computed tomography angiography (CCTA), aid and facilitate diagnosis of the fistula site, origin, and terminus ( 4 ). In almost all intervention centers, 2D and 3D TEE and TTE are used in the supplement to cineangiography for verifying the exact anatomy of this anomaly and successful CAF closure ( 6 ), which further shows the supplementary role of modern imaging techniques. Herein, we describe and compare the disease course of two patients with CAFs, left circumflex artery (LCx), one to the coronary sinus and the other LCx to superior vena cava, to emphasize the role of multimodal imaging in the diagnosis and prognosis in patients suspected of CAF.…”

Section: Introductionmentioning

confidence: 99%

Case report: Multimodal imaging diagnosis of a giant coronary artery fistula: A report of two cases

Sharifkazemi

Mohseni-Badalabadi

Hosseinsabet

et al. 2022

Front. Cardiovasc. Med.

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Being a very rare cardiac disease, most cases of coronary artery fistula (CAF) are genetic. Complications such as coronary steal syndrome, myocardial infarction, heart failure, or tamponade can manifest following the abnormal communication that the fistula creates between the coronary arteries and cardiac chambers or major vessels and the subsequent shunt. Most CAFs are small and asymptomatic, making diagnosis difficult. In symptomatic patients, the initial diagnostic workup is generally made with chest radiography and electrocardiography. Other imaging modalities have also been suggested to improve diagnostic accuracy. Cardiac catheterization and coronary angiography are currently the gold standard for diagnosis and planning the intervention, as they can recognize the quantum of the shunt as well as complications of a fistulous track (e.g., aneurysm formation, thrombus, leak, and the number of openings to the receiving chamber/vessel); however, this invasive method may be associated with risk. Herein, we report two patients with giant CAFs, one from the left circumflex artery to the coronary sinus and the other to the superior vena cava. Moreover, we describe how multimodal imaging, including two- and three-dimensional transesophageal echocardiography, coronary cineangiography, coronary computed tomography angiography, and enhanced chest computed tomography, can facilitate diagnosis and estimate the disease course in such patients. We believe that using multimodal imaging cannot only help the initial diagnosis regarding the presence of a CAF and the accurate anatomical site of the fistula in the patient but can also help predict the disease course and choose the most suitable treatment modality. Therefore, we suggest multimodal imaging be done to diagnose patients suspected of CAF. However, invasive cineangiography should be necessarily followed, regardless of whether an intervention is planned or not.

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A Coronary Artery Fistula Successfully Closed With the Precise Guidance of Three-Dimensional Echocardiography

Cited by 6 publications

References 2 publications

Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

Coronary Artery Fistulas

Case report: Multimodal imaging diagnosis of a giant coronary artery fistula: A report of two cases

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