CTA analysis of 482 cases of coronary artery fistula: A large‐scale imaging study

Abstract

Objective The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types. Materials and Methods From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow‐up DSCT images were also evaluated. Analyze the difference between the coronary‐pulmonary artery fistula (CPAFs) group (380) and the coronary‐cameral fistula (CCF) group (99). Results Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated. Conclusions Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.

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

“…It is an alternative to complications caused by surgery. The curvature of the developing abnormal vessels necessitates the use of stiffer wires for support, which can complicate the procedure [ 14 ]. In our case, the percutaneous method was attempted but was unsuccessful due to widespread aneurysms.…”

Coronary artery fistula following surgical myectomy for hypertrophic obstructive cardiomyopathy: a case report

“… 7 , 8 They have been detected in 0.05–0.25% of invasive coronary angiogram series and 0.5% of dedicated CTCA series. 10 Whilst exact incidence rates in post-cardiac interventional populations (e.g. post-surgical myectomy) are unknown, some case series authors suggest that they may be more common than thought, highlighted by one case series demonstrating a 23% incidence post-surgical myectomy.…”

“… 7 The majority (80%) are reported to involve the right coronary artery, draining into right-sided cardiac structures with only 3–5% draining into the LV, although these data are not consistent. 7 , 10 , 12 …”

“…Furthermore, echocardiography lacks the spatial resolution to confirm coronary anatomy, particularly in cases of tortuous arteries and small shunts. 13 , 14 Invasive coronary angiography is considered the gold standard for diagnosis and evaluation of CAFs, 10 , 14 although CTCA (especially with post-treatment technologies such as cinematic rendering) is considered more sensitive than invasive angiography for the detection of small fistulae and for evaluating the complex anatomical features (e.g. origin, course, drainage site, fistula number and diameter, and aneurysms) and associated coronary artery lesions (e.g.…”

“…atherosclerotic plaques and myocardial bridges) necessary for surgical planning. 10 , 14 Photon-counting CT will likely further increment the utility of cardiac CT. Currently, the role of cardiac magnetic resonance imaging in the evaluation of CAF is limited by low spatial resolution, long acquisition times and frequently encountered contraindications.…”