Prevalence and types of coronary artery fistulas detected with coronary CT angiography.

OBJECTIVE: The prevalence of coronary artery fistula (CAF) based on coronary angiographic findings has been reported. However, the number of incidentally found CAFs is increasing as coronary CT angiography (CTA) has become popular. The purpose of this study was to determine the prevalence and types of CAFs detected with coronary CTA. MATERIALS AND METHODS: Between March 2009 and November 2011, 6341 patients underwent coronary CTA at one institution. The prevalence of CAF was retrospectively evaluated, and the morphologic features were analyzed, including vessel of origin, drainage site, size, and presence of an aneurysmal sac. We also analyzed cardiac and pulmonary findings. RESULTS: Among 6341 patients, 56 (0.9%) patients had CAF. The types of CAF detected, in decreasing frequency, were coronary to pulmonary artery fistula (43 cases [76.8%]), coronary to bronchial artery fistula (five cases [8.9%]), coronary artery to cardiac chamber fistula (five cases [8.9%]), combined coronary to pulmonary and coronary to bronchial artery fistula (two cases [3.6%]), and coronary artery to superior vena cava fistula (one case [1.8%]). Lung parenchymal or vascular anomaly was more frequently noted in coronary to bronchial artery fistulas, combined coronary to pulmonary and coronary to bronchial artery fistulas, and coronary artery to superior vena cava fistulas than in coronary to pulmonary artery and coronary artery to cardiac chamber fistulas. CONCLUSION: The prevalence of CAF at coronary CTA was 0.9%, which is higher than the known prevalence based on conventional angiographic findings (0.05-0.25%). Furthermore, the most common type of CAF in this study was coronary to pulmonary artery, whereas coronary artery to ventricle fistula was previously considered the most common type in studies conducted with conventional angiography. Coronary CTA is a useful, noninvasive imaging modality for the detection of CAF.

[Incidence and classification diagnosis of coronary artery fistula at dual-source CT coronary angiography].

OBJECTIVE: To evaluate the incidence, types and clinical significance of coronary artery fistula (CAF) on CT coronary angiography (CTCA). METHODS: A total of 48 533 consecutive patients undergoing CTCA at 4 Chinese hospitals were retrospectively analyzed. The incidence, types and clinical significance of CAF were retrospectively summarized. RESULTS: One hundred and two patients had CAF with the incidence of 0.21% (102/48 533). Among them, coronary to pulmonary artery fistulas were seen in 92 patients (90.2%, 92/102), coronary to right atrium fistula in 4 (3.9%, 4/102), coronary to right ventricular fistula in 2 (2.0%, 2/102), coronary to right ventricular fistula in 2 (2.0%, 2/102), coronary to left atrium fistula in 1 (1.0%, 1/102) and coronary to small cardiac vein in 1 (1.0%, 1/102). Among 92 coronary to pulmonary artery fistulas, fistulas originated from both coronary arteries in 46 patients (50.0%, 46/92), from left coronary artery in 28 (30.4%, 28/92) and right coronary artery in 11 (12.0%, 11/92) and the remaining 7 (7.6%, 7/92) coronary to pulmonary artery fistulas were associated with extracardiac communications. CONCLUSION: The incidence of CAF is 0.21% with a predominance of coronary to pulmonary artery fistulas (90.2%). The most common type of CAF is coronary to pulmonary artery fistulas from both coronary arteries (50.0%). Dual source CTCA can clearly visualize types and abnormal vessels so that it plays an important role in the diagnosis and preoperative evaluation of CAF.

Arteria trigeminal persistente asociada a aneurisma de carótida intracavernosa: comunicación de un caso / Persistent primitive trigeminal artery with cavernous carotid aneurysm (Case report)

Se presenta el caso de una paciente que asociada a una arteria trigeminal persistente presentó un aneurisma de gran tamaño en la carótida intracavernosa ipsilateral. Es estudiada con resonancia magnética y resonancia magnética angiográfica. Revisamos la clasificación angiográfica de Saltzamn y la frecuente asociación a malformaciones vasculares

Arteria trigeminal persistente asociada a aneurisma de carótida intracavernosa: comunicación de un caso / Persistent primitive trigeminal artery with cavernous carotid aneurysm (Case report)

Se presenta el caso de una paciente que asociada a una arteria trigeminal persistente presentó un aneurisma de gran tamaño en la carótida intracavernosa ipsilateral. Es estudiada con resonancia magnética y resonancia magnética angiográfica. Revisamos la clasificación angiográfica de Saltzamn y la frecuente asociación a malformaciones vasculares (AU)

Congenital coronary artery anomalies angiographic classification revisited.

Many fragmental classification of coronary artery anomalies (CAAs) exist, but a simple practical angiographic classification for angiographers has been never proposed. This study is aimed to suggest a simplified angiographic classification of congenital CAAs based on just a few univocal common angiographic patterns. The authors reviewed 5100 coronary angiographies in order to select CAAs patients and identify simple common angiographic features. Sixty-two patients (1.21%, female/male 20/42, mean age 65.3 +/- 10.6 years) had CAA on coronary angiography. The authors identified seven classes for seven angiographic patterns: I--hypoplasia/atresia, II--hyperdominance, III--fistula, IV--originating from wrong sinus, V--originating from other arteries, VI--splitting, and VII--tunnelling. A, P, B, R, L, PA, AO refer to anterior, posterior or passage between the aorta and pulmonary artery and to right, left, pulmonary artery and aorta. Three blind observers were be able to categorize all the CAAs according to this classification with no inter-observer differences: 3.2% were classified as class I, 8.1% as class II, 3.2% as class III, 24.2% as class IV, 22.5% as class V, 29% as class VI, and finally 9.7% as class VII. Eleven patients (17.7%) had 'A' passage, 10 (16.1%) 'P' passage and 9 (14.5%) 'B' passage. Twelve patients (19.5%) had anomalous origin from the right sinus of Valsalva, 2 (3.2%) from the left. This simplified classification was applicable to all most significant CAAs and in the authors' view it may make for a more rapid and univocal CAA angiographic description.

[Multiple pulmonary coronary fistulae. Apropos of a case]. / Fistules coronaro-artérielles pulmonaires multiples. A propos d'un cas.

Coronary-pulmonary fistula is a rare congenital anomaly. It is usually detected fortuitously in adulthood during a coronary angiography carried out to assess signs of myocardial ischemia. Multiple coronary fistulae are still more rare. Coronary angiography evaluates the lesions and indicates the most appropriate treatment. The congenital lesions are frequently combined with atheromatous lesions. The case described is that of a double fistula in a 61-year old man which was revealed by angina; the stenoses and occlusions which accompanied the fistulae lead to a discussion of their atheromatous nature and the nature of the pathological link between them: is this fortuitous or are they a progressive complication? Treatment involves both exclusion of the fistulae and coronary revascularization.