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Noninvasive diagnosis of coronary artery fistula by Doppler color flow mapping
M Shakudo1, J Yoshikawa, K Yoshida
1Department of Cardiology, Kobe General Hospital, Japan.
Insights
Doppler color flow imaging effectively visualizes coronary artery fistulas and their drainage sites. This technique aids in diagnosing these vascular abnormalities and confirming successful surgical repair.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Coronary artery fistulas (CAFs) are uncommon congenital or acquired vascular anomalies.
- Accurate diagnosis and localization of CAFs are crucial for effective management and surgical planning.
Purpose of the Study:
- To evaluate the diagnostic utility of two-dimensional echocardiography and Doppler color flow mapping in identifying coronary artery fistulas.
- To assess the ability of Doppler color flow imaging to visualize shunt flow and determine the fistula's drainage site.
Main Methods:
- A study involving 16 patients with confirmed coronary artery fistulas.
- Utilized two-dimensional echocardiography and Doppler color flow mapping for imaging.
- Coronary angiography and surgical findings served as gold standards for comparison.
Main Results:
- Doppler color flow imaging visualized dilated coronary arteries in 7 of 16 patients, a finding absent in controls.
- The technique accurately identified fistula drainage into the right atrium, right ventricle, or pulmonary artery.
- Abnormal flow signals were detected in the feeding coronary artery and at the fistula's entry site into the cardiac chambers.
Conclusions:
- Doppler color flow imaging is a valuable non-invasive tool for diagnosing coronary artery fistulas.
- It effectively visualizes abnormal shunt flow and helps determine the fistula's anatomical course and termination.
- Intraoperative application of Doppler imaging can confirm complete surgical ligation of the fistula.
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.