Coronary-Pulmonary Artery Fistulas

Verdini, Daniel; Vargas, Daniel; Kuo, Anderson H.; Ghoshhajra, Brian B.; Kim, Philip; Murillo, Horacio; Kirsch, Jacobo; Lane, Michael F.; Restrepo, Carlos S.

doi:10.1097/rti.0000000000000232

Cited by 74 publications

(68 citation statements)

References 64 publications

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“…The majority (89%) of CAFs drain into the pulmonary trunk rather than into other segmental pulmonary arteries. According to findings in a recent study by Verdini et al (41), two types of coronary-topulmonary artery fistulas occur. The first type is a single prominent fistulous connection between the LAD or RCA and the main pulmonary trunk…”

Section: Coronary Artery-to-pulmonary Artery Fistulamentioning

confidence: 92%

“…When a CAF drains into the pulmonary arteries, the murmur is best heard in the second intercostal space, left of the sternum. At cardiac CT angiography, a coronary-to-pulmonary artery fistula appears as an abnormal contrast blush, which is also referred to as the contrast shunt sign, in a relatively less-opacified pulmonary trunk or as a well-visualized fistulous tract between the coronary artery and pulmonary trunk (41). Although previous study investigators (4,25) have reported CAFs originating from the RCA to be more common than those originating from the LCA, results of a recent systematic review (41) showed the LCA to be the most common origin site (84% of cases), followed by the RCA (38% of cases).…”

Section: Coronary Artery-to-pulmonary Artery Fistulamentioning

confidence: 99%

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Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. CAFs are rare, and most affected patients are asymptomatic. However, these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters. Although most CAFs are asymptomatic in young patients, symptoms and complications become more frequent with increasing age. CAFs are characterized by variable clinical manifestations that are based on the size, origin, and drainage site of the fistula. In symptomatic cases, surgical ligation or percutaneous transcatheter closure is often recommended. Although CAFs historically have been evaluated with conventional invasive angiography, electrocardiographically gated cardiac computed tomographic (CT) angiography has emerged as the noninvasive alternative modality of choice owing to the high spatial and temporal resolution and short acquisition time. Furthermore, three-dimensional volume-rendered CT angiograms facilitate accurate assessment of the complex anatomy of CAFs, including their origin, drainage site, and complexity and the number and size of fistulous tracts. Knowledge of these characteristics is crucial for therapeutic planning. Radiologists must be aware of the pathophysiology, clinical manifestations, and characteristic CT angiographic findings of CAFs; appropriate CT angiographic protocols for evaluation of various CAFs; and the role of CT angiography in preprocedural planning and follow-up. Online supplemental material is available for this article. RSNA, 2018.

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Section: Coronary Artery-to-pulmonary Artery Fistulamentioning

confidence: 92%

Section: Coronary Artery-to-pulmonary Artery Fistulamentioning

confidence: 99%

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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“…Management of CPFs could consist of conservative watching or surgical ligation or percutaneous interventional techniques including coil embolization and placement of covered stents across the origins of feeding arteries . Occasionally, CPFs can have complex architecture with multiple feeding arteries and their management could be more challenging .…”

Section: Discussionmentioning

confidence: 99%

Embolization of a complex coronary to pulmonary artery fistula using balloon assisted liquid embolic injection: A novel technique

Jagadeesan

Liao

Raveendran

2018

Cathet Cardio Intervent

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Complex Coronary artery to Pulmonary artery fistulas (CPFs) can be difficult to manage with embolization or ligation. An 88-year-old woman with exertional angina was found to have a complex precordial CPF, severe Mitral regurgitation, and Pulmonary Hypertension. CPF treatment was recommended prior to minimally invasive mitral valve replacement (to avoid postoperative myocardial ischemia from worsened steal). The CPF was supplied by multiple branches from the LAD and RCA, and formed a complex common varicosity with multiple drainage channels to the pulmonary artery. The CPF was treated by injecting a liquid embolic agent, Ethylene Vinyl Alcohol Copolymer (Onyx, Medtronic, MN), into two of the feeding arteries arising from the RCA through a Scepter C Dual lumen balloon micro catheter (Microvention, Aliso Viejo, CA. This resulted in complete obliteration of the fistula, and the patient subsequently underwent successful mitral valve replacement surgery.

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“…Coronary-to-pulmonary artery fistulas are rare coronary connections (literature rates of <0.7%) most frequently originating from the left main coronary artery, the left anterior descending artery or the right coronary artery and draining into the main pulmonary artery [1]. Although they are often incidental findings (CTCA has increased diagnosis rates), patients may present with angina, dyspnoea, congestive heart failure, pulmonary hypertension, arrhythmias and sudden cardiac death.…”

Section: Answermentioning

confidence: 99%