Noninvasive diagnosis of coronary artery fistula by doppler color flow mapping

Abstract

Sixteen patients with coronary artery fistula proved by coronary angiography or surgery were studied using two-dimensional echocardiography and Doppler color flow mapping. The coronary artery fistula drained into the right atrium in 4 patients, the right ventricle in 2 and the pulmonary artery in 10. The dilated coronary artery was visualized in 7 of the 16 patients with a fistula, as compared with none of the 40 control subjects. These 7 patients included 5 of 6 patients with a fistula draining into the right atrium or right ventricle and only 2 of 10 patients with a fistula draining into the pulmonary artery. Abnormal flow signals in the dilated coronary artery were visualized with Doppler color flow mapping in five of these seven patients. Color flow imaging visualized abnormal flow signals with mosaic appearance in the pulmonary artery in eight patients, the right atrium in four and the right ventricle in two. The chamber in which abnormal signals were detected corresponded with the entry site of the fistula by angiography. Intraoperative imaging during surgical repair was needed in two cases to confirm ligation of all arteries feeding into the fistula network. In conclusion, Doppler color flow imaging is diagnostically useful to visualize shunt flows originating from the opening or exit of a coronary artery fistula. Furthermore, intraoperative use of this technique may provide confirmation of successful surgical ligation of the fistula.

Failure of color flow mapping to identify coronary artery to pulmonary artery fistula

“…Although color flow mapping can be uniquely valuable in patients with coronary-cameral fistulas [5,7,9,10], both false-positive [3] and false-negative results (the current case) occur. Clinicians should not hesitate to proceed to angiography in patients with unexplained continuous murmurs even if results of echocardiography with color flow mapping are negative.…”

“…Unlike the two false-negative cases reported by Shakudo and coworkers [9], the false-negative result of color flow mapping in this case is clinically important. This fistula was of significant size, causing a continuous murmur and an oximetrically detectable left-to-right shunt.…”

“…Except for one false-positive result [3] and two adult patients without murmurs in whom coronary to pulmonary artery fistulae were incidentally discovered [9], color flow mapping has identified the site of coronary-cameral connection in all reported cases. Indeed, coronary-cameral fistula has been considered a lesion for which the clinical utility of color flow mapping is best established [1].…”

“…Color flow mapping has identified coronary artery fistulas to the left ventricle [7], right ventricle [5, 6, 9-11], right atrium [2-4, 8, 9, 11], and pulmonary artery [9]. Although false-positive diagnosis of coronary-cameral fistula by color flow mapping has been reported [3], this report details the first case in which color flow mapping was unable to identify a coronary-cameral fistula despite presence of the typical continuous murmur.…”

‘Hot spot’–‘cool cath’: Myocardial perfusion scintigraphic findings in coronaro-cameral micro-communications

“…Right ventricular biopsy may leave cut arterial vessel tips forming acquired communications between the vessel and a chamber [4]. Most of the CCFs are identified incidentally during coronary angiography, though Doppler echocardiography can identify good sized CCFs [5]. Our case describes a unique case of Fhot spot_ on SPECT-MPI scan, which was later confirmed to be a CCF angiographically.…”