Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography

Abstract

Background: To analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA).Methods: This was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion.Results: A total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without.The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees. Conclusions:The 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.

Successful Surgical Treatment for Ruptured Aneurysm of Coronary-Pulmonary Artery Fistula Complicated With Cardiac Tamponade

“… 5 As a result, a CPAF in most cases is found to be located on the left anterolateral side of the PA, with the remaining showing no dominant portion. 3 , 5 In the present patient, the CPAF originating from the LAD formed an aneurysm, whereas CPAF originating from the RCA was small and did not show communication to the aneurysm. Based on those findings, the origin of the fistula from the LAD was ligated, and the drainage site in the PA was closed.…”

“…Although 19% to 29% of CPAF cases have been reported to be complicated with an aneurysmal dilatation, rupture of a CPAF aneurysm is rare. 1 , 3 Generally, coronary artery aneurysm larger than 3 cm in size is an indication for surgery because of risk of rupture. 4 However, in patients with an aneurysm associated with a CPAF, some reports have noted a ruptured aneurysm sized 1 to 2 cm, the same as found in the present case.…”

“…Regarding the origin of a CPAF, a fistula may arise from the LAD, left circumflex artery, or RCA and can also originate from both the left and right coronary arteries. 1 , 3 As for the drainage site of CPAF, the left lateral side of the main PA trunk is most common (82%), whereas the others reported are the right lateral (12%) and anteromedial (6%) sides. 5 As a result, a CPAF in most cases is found to be located on the left anterolateral side of the PA, with the remaining showing no dominant portion.…”

Coronary artery fistula with or without aneurysm: A large comparative study

“…A large CAF fistulous diameter may lead to high shunts as well as high coronary blood flow, resulting in a high likelihood of aneurysm. Hang et al [ 18 ] have reported a similar conclusion that the average diameter of the fistula in the aneurysm group was significantly larger than that in the CAF without aneurysm group (2.99 ± 1.37 vs 2.54 ± 1.67). However, no significant difference was identified between the two groups in their study ( P = 0.499), which may be due to the small sample size of patients in the two groups (n = 8 vs 14).…”

Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction

“…The calculated incidence of aneurysm formation was 59.09%. It was reported that all fistulas resulted from a single drainage area with an average diameter of 2.81 ± 1.48 mm, and the diameter of the fistula with an aneurysm was larger than that without an aneurysm [ 4 ]. It has been reported that more than half of the patients with a coronary-pulmonary arteriovenous fistula were asymptomatic, and the fistula connecting the coronary artery to the pulmonary artery could have single or multiple origins.…”