Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review

Abstract

Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.

Case report: Surgical repair for left main coronary artery to right atrium fistula with endocarditis

“…Echocardiography, CT, MRI, and coronary angiography are useful diagnostic modalities ( 8 ). In particular, CT has become an important noninvasive method for coronary artery anomalies, and it could clearly diagnose different types of CAF ( 9 ).…”

Coronary‐cameral fistula in an infant patient: An incidental diagnosis

“…CAFs can be classified based on their size: small, medium, or large, depending on whether the fistula diameter is <1, between 1 and 2, or >2 times the largest diameter of the coronary vessel that does not supply the coronary fistula. They can also be categorized according to the drainage site: coronary‐cameral fistula (the most common), coronary‐to‐pulmonary artery fistula, coronary artery‐to‐coronary sinus, and coronary artery‐to‐bronchial artery fistula 2,9 . A shunt from left to right (coronary artery to right vessels or chambers) leads to an ongoing flow throughout the entire cardiac cycle, driven by the lower pressure within the right structure (vessel or chamber) in comparison to the myocardial capillaries or arterioles.…”

“…Selective invasive coronary angiography has been replaced by TTE, the now preferred initial assessment method. TTE can show dilated coronary arteries (CAFs that are large and/or have a diameter greater than 3 mm) and distal drainage via color flow mapping in CAF cases 9 . However, it is less effective for small shunts and pulmonary artery fistulas.…”

“…Hyun Woo Goo's 2021 review outlined the following as contraindications 9 for percutaneous transcatheter closure: fistulas draining near the atrioventricular annulus, extreme tortuosity, a very small patient size that complicates the procedure, as well as multiple communications and drainage sites.…”

“…They can also be categorized according to the drainage site: coronary-cameral fistula (the most common), coronary-to-pulmonary artery fistula, coronary artery-to-coronary sinus, and coronary artery-to-bronchial artery fistula. 2,9 A shunt from left to right (coronary artery to right vessels or chambers) leads to an ongoing flow throughout the entire cardiac cycle, driven by the lower pressure within the right structure (vessel or chamber) in comparison to the myocardial capillaries or arterioles. This often gives rise to a volume overload on the right side, although this pathophysiological mechanism can also involve chambers on the left side.…”