Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery fistulas (CAFs) are uncommon abnormal connections between coronary arteries and cardiac chambers or vessels.
• While often asymptomatic, CAFs can lead to significant hemodynamic alterations and complications, particularly with increasing age.
• Clinical presentation varies based on fistula characteristics, necessitating accurate anatomical assessment.

Purpose of the Study:

• To highlight the role of cardiac computed tomographic (CT) angiography in evaluating coronary artery fistulas.
• To emphasize the importance of understanding CAF pathophysiology, clinical features, and CT findings for effective management.
• To guide radiologists on optimal CT angiographic protocols and the utility of CT in preprocedural planning and follow-up.

Main Methods:

• Review of coronary artery fistula evaluation using conventional invasive angiography.
• Emphasis on electrocardiographically gated cardiac CT angiography as a noninvasive alternative.
• Utilization of three-dimensional volume-rendered CT angiograms for detailed anatomical assessment.

Main Results:

• Cardiac CT angiography offers high spatial and temporal resolution for evaluating CAFs.
• 3D CT angiograms accurately depict fistula origin, drainage, complexity, and tract characteristics.
• CT findings are crucial for planning surgical or percutaneous closure interventions.

Conclusions:

• Cardiac CT angiography is the modality of choice for noninvasive assessment of coronary artery fistulas.
• Radiologists require comprehensive knowledge of CAFs and their CT imaging features.
• CT angiography plays a vital role in the preprocedural planning and post-treatment follow-up of patients with CAFs.