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Coronary artery fistulas in children. Evaluation with 64-slice multidetector CT
1Radiology Department, Children's Hospital of Fudan University Shanghai, Shanghai, People's Republic of China.
Insights
Sixty-four-slice multidetector computed tomography (MDCT) angiography accurately diagnosed coronary artery fistulas (CAF) and their relationship to surrounding structures. This noninvasive imaging tool aids in planning therapeutic strategies for CAF.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Pediatric Cardiology
Background:
- Coronary artery fistulas (CAF) present complex anatomical variations.
- Accurate pre-procedural diagnosis of CAF is crucial for effective treatment planning.
- Understanding the relationship between CAF and adjacent structures is essential for intervention or surgery.
Purpose of the Study:
- To evaluate the feasibility of 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF.
- To assess the accuracy of MDCT in delineating CAF morphology and spatial relationships.
- To compare MDCT measurements with intra-procedural or surgical findings.
Main Methods:
- Retrospective analysis of coronary MDCT angiography in 10 pediatric patients with CAF.
- Two blinded readers evaluated MDCT for origin, course, and distal entry site of CAF.
- MDCT measurements of fistula diameters were compared with intervention or surgical data.
Main Results:
- MDCT clearly depicted the origin, course, and distal entry site of CAF in all patients.
- Diagnosis of CAF by MDCT correlated well with intervention or surgical findings.
- Excellent correlation (R = 0.90-0.92) was observed between MDCT and transcatheter occlusion for diameter measurements.
Conclusions:
- 64-slice MDCT angiography effectively visualizes the entire shape and course of CAF.
- MDCT provides detailed information on surrounding structures, aiding surgical or interventional planning.
- Coronary MDCT angiography is a valuable noninvasive tool for diagnosing and planning CAF treatment.
Objectives:
There are various types of coronary artery fistulas (CAF) with complex shapes. Therefore, it is important to make a correct diagnosis and to understand the relationship of the CAF to the adjacent structures before transcatheter occlusion or surgery. This study evaluated the feasibility of using 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF.
Methods:
Two readers who were blinded to the results of echocardiography, intervention, or surgery retrospectively evaluated the coronary MDCT appearances of CAF in 10 patients (4 boys and 6 girls; mean age, 2.9 years; range, 1-6 years). The origin, course, and distal entry site of the fistula were determined. The diameters of the origin and the distal entry site were measured and compared with those seen during intervention or surgery.
Results:
The origin, course, and distal vessel entry site of the CAF were clearly outlined in all patients by MDCT. The distal vessel draining site involved a single entry vessel in all patients. Seven fistulas involved the right coronary artery, and three involved the left coronary artery. Four fistulas drained into the right ventricle, four into the right atrium, and two into the left ventricle. The diagnosis of CAF using MDCT was in accordance with diagnoses made during intervention or surgery. There was an excellent correlation between MDCT and transcatheter occlusion in quantifying the diameters of the origin and distal entry site (R = 0.90 and 0.92, respectively, P < 0.05).
Conclusion:
Coronary 64-slice MDCT angiography depicted the whole shape and course of the CAF as well as of the surrounding structures. It may serve as a noninvasive diagnostic tool when planning a therapeutic strategy.
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