Aberrant fistula arteries from the left main branch and right coronary artery to the left pulmonary arterial sinus demonstrated by multislice computed tomography

Non-invasive recognition of generalized coronary arteriosystemic fistulae by contrast echocardiography and multidetector CT

“…We performed low mechanical index contrast echocardiography with an intravenous bolus injection of SonoVue, sulfur hexafluoride microbubble contrast agent, and demonstrated multiple fistulous communications draining exclusively into the left ventricle and subsequently streaming to the left ventricular outflow tract. MDCT may provide superior visualization of aneurysmal coronary fistulas and the anatomic relationship to adjacent structures [12][13][14]. We recognized multiple fistulous communications in the left ventricular myocardium, increased enhancement predominantly in the anterolateral left ventricular wall, and the portal of entry of connection of the fistulae to the left ventricular cavity by MDCT coronary angiography.…”

“…Coronary arterial fistulae draining into the left ventricle (arterio-systemic) are relatively uncommon, with a reported incidence of 1.2% of all coronary artery fistulae [4,5]. Furthermore, the arteriosystemic fistulae involving the left coronary artery or at least two major coronary arteries (''multiple'' or ''bilateral''), or three (''generalized'') major coronary arteries are extremely rare [8][9][10][11][12][13][14]. The etiology of these fistulous communications has been attributed to a persistence of embryonic sinusoids that are usually obliterated in normal development [6,7].…”

“…In the past, the definite diagnoses of generalized arteriosystemic fistulae were only established by CAG. However, it has been recently reported that coronary artery fistulae can be detected by various kinds of non-invasive cardiac imaging, such as TTE, contrast echocardiography, and MDCT coronary CTA [9][10][11][12][13][14]. There are few reports that contrast echocardiography using agitated saline solution injected into the aortic catheter or intravenous injection of Levovist have showed the passage of microcavitations into the left and right ventricles confirming the connection of the fistula to both chambers [10,11].…”

“…Generalized coronary arteriosystemic fistulae are reported to be exceedingly rare [4,5]. In the past, the definite diagnoses of such patients have only been made by CAG; however, it has recently been reported that coronary artery fistulae can be detected by various kinds of non-invasive cardiac imaging modalities, such as transthoracic echocardiography (TTE), contrast echocardiography, and MDCT coronary angiography (coronary CTA) [9][10][11][12][13][14]. In this report, a case involving an elderly woman in whom generalized coronary arteriosystemic fistulae were incidentally identified during CAG, as well as non-invasively with contrast echocardiography and coronary CTA, is described.…”

Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

“…This technology may be applied for the evaluation of CAF, including the origin, course, and drainage of the fistulae. The three-dimensional geometry of MSCT can show more details regarding the spatial relationship with contiguous and surrounding structures and can provide details about the tortuous anatomy of the vascular malformation as an important advantage over other mentioned diagnostic modalities, particularly in volume-rendered views (24) . Magnetic resonance imaging have also become alternative methods to evaluate the anatomy, flow, and function of CAF.…”