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Published on: August 28, 2018
Coronary artery fistulas morphology in coronary computed tomography angiography
E Czekajska-Chehab1, M Skoczyński2, P Przybylski1
11 st Department of Radiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland.
Insights
Coronary artery fistulas (CAFs) are detected using coronary computed tomography angiography (coronary CTA). A new classification system helps predict the impact of fistula morphology on cardiac function.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Coronary artery fistulas (CAFs) are uncommon vascular anomalies.
- Their evaluation often relies on advanced imaging techniques.
Purpose of the Study:
- To assess the utility of coronary computed tomography angiography (coronary CTA) in detecting and characterizing CAFs.
- To investigate correlations between CAF morphology and cardiac function/clinical data.
Main Methods:
- Retrospective analysis of 14,308 patients who underwent coronary CTA.
- Data collected included patient referrals and CTA findings.
- A novel morphological classification for CAFs was developed.
Main Results:
- CAF prevalence was 0.43%; diagnosis was often incidental.
- Fistulas draining into cardiac chambers were shorter than others.
- Spiral, linear, aneurysmal, grid-like, and mixed types were identified.
- Grid-like fistulas were associated with reduced left ventricle ejection fraction.
Conclusions:
- Coronary CTA is effective for CAF detection and morphological assessment.
- The proposed classification aids in predicting the clinical significance of CAFs.
- Further research is warranted to validate the classification's predictive power.
Background:
The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data.
Materials And Methods:
A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals.
Results:
Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients.
Conclusions:
Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.
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