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Coronary artery fistulas in children

Evaluation with 64-slice multidetector CT

Koronararterienfisteln bei Kindern

Beurteilung mit 64-Schicht-Multidetektor-CT

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Abstract

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.

Zusammenfassung

Ziel

Es gibt verschieden Arten von Koronararterienfisteln mit komplexen Formen, daher ist es wichtig, die korrekte Diagnose zu stellen und die Beziehungen zu den benachbarten Strukturen vor der Okklusion via Katheter oder Operation zu kennen. In der vorliegenden Studie wurde die Durchführbarkeit einer 64-Schicht-Multidetektor-Computertomographie(MDCT)-Angiographie zur Diagnose einer Koronararterienfistel beurteilt.

Methoden

Zwei Beurteiler, die in Bezug auf die Ergebnisse der Echokardiographie, Intervention oder Operation verblindet waren, werteten die Koronar-MDCT-Aufnahmen der Koronararterienfisteln bei 10 Patienten aus (4 Jungen, 6 Mädchen; Durchschnittsalter: 1,9 Jahre, Spannweite: 1–6 Jahre). Fistelursprung, -verlauf und distale Eintrittsstelle wurden bestimmt. Der Durchmesser des Ursprungs und der distalen Eintrittsstelle wurden gemessen und mit jenen bei Intervention oder Operation verglichen.

Ergebnisse

Ursprung, Verlauf und distale Gefäßeintrittsstelle der Koronararterienfistel wurden bei allen Patienten mittels MDCT klar dargestellt. An der distalen Gefäßabflussstelle handelte es sich bei sämtlichen Patienten um ein einzelnes Eintrittsgefäß. Bei 7 Fisteln betraf es die rechte Koronararterie und bei 3 die linke. Bei den distalen Abflüssen der Koronararterienfistel flossen 4 Fisteln in den rechten Ventrikel ab, 4 in den rechten Vorhof und 2 in den linken Ventrikel. Die Diagnose per MDCT stimmte mit der Intervention oder Operation überein. Es bestand eine ausgezeichnete Korrelation zwischen MDCT und Okklusion via Katheter hinsichtlich der Quantifizierung der Durchmesser des Ursprungs und der distalen Eintrittsstelle (r = 0,90 bzw. 0,92; p < 0,05).

Fazit

Mit der koronaren 64-Schicht-MDCT-Angiographie ließen sich die Form, der Verlauf der Koronararterienfistel und die umgebenden Strukturen zur Gänze darstellen. Das Verfahren kann als nichtinvasives diagnostisches Mittel zur Planung des therapeutischen Vorgehens dienen.

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Acknowledgments

This study was supported by funding of Shanghai Science and Technology Committee [No. 12ZR1403400].

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Radiology Department, Children’s Hospital of Fudan University Shanghai, Shanghai, People’s Republic of China

    X. Hu, Q. Shen & M. Pa

  2. Heart Centre, Children’s Hospital of Fudan University, Shanghai, People’s Republic of China

    L. Wu, F. Liu & G. Huang

Authors
  1. X. Hu
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  2. L. Wu
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  3. F. Liu
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  4. Q. Shen
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  5. M. Pa
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  6. G. Huang
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Corresponding author

Correspondence to G. Huang.

Additional information

X.H. and L.W. contributed equally to this paper.

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Hu, X., Wu, L., Liu, F. et al. Coronary artery fistulas in children. Herz 38, 729–735 (2013). https://doi.org/10.1007/s00059-013-3786-2

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  • DOI: https://doi.org/10.1007/s00059-013-3786-2

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