Imaging Examinations Of Congenital Coronary Artery Fistula

Objectives To evaluate the clinical value of imaging examinations in diagnosing congenital coronary artery fistula.Methods 62 congenital coronary artery cases (male 29, female 33) all underwent X-ray, ultrasonic cardiography, and angiography. 11 cases underwent multi-slice spiral computed tomography examination additionally.Results Correct diagnoses were obtained in 10 cases by X-ray, 56 cases by ultrasonic cardiography, 10 cases by computed tomography, and all cases by angiography. In the 62 cases, there were 34 (54. 8%) originating from the left coronary arteries, 23 (37. 1%) originating from right coronary arteries, and 5 (8. 1%) originating from both coronary arteries. There were 19 (30. 6%) fistulae draining into left ventricle, 18 (29. 1%) into right ventricle, 17 (27.4%) into right atrium, 6 (9.7%) into pulmonary artery, and 1 (1.6%) into left atrium and coronary sinus respectively.Conclusion The X-ray in diagnosing of congenital coronary artery fistula was limited. Angiography was still the gold standard. Ultrasonic cardiography should be the first examination to exclude the diagnosis of congenital coronary artery fistula. Multi-slice spiral computed tomography or magnetic resonance imaging can be used as adjunct to coronary angiography. Objectives Interventional therapy of coronary artery fistula (CAF) has emerged as a successful alternative to surgery. We described our experiences in 20 patients who were taken up transcatheter closure of CAF.Methods 20 patients (10 males, 10 famales, aged 2-57 years) with coronary artery fistula all underwent percutaneous transcatheter closure. Site of origin of these fistulae were: right coronary artery in 12 (60%) , left anterior descending coronary artery in 2 (10%), and left circumflex coronary artery in 3 patients (15%). Drainage site of these fistulae were: right atrium in 10 (50%) , right ventricle in 6 (30%) , pulmonary artery in 2 (10%), left ventricle in 1 (5%), and coronary sinus in 1 patient (5%). All of these fistulae were congenital and have only one orificium fistula respectively.Results Interventional therapy was successful in 15 (75%) patients. Technical success was achieved 75%. Two kinds of occlusion devices used to close these fistulae were: Cook coils in 5 and patent ductus occluders in 10. Angiography after the interventional procedure revealed complete occlusion in 12 (80%) and minimal residual flow in 3 (20%). Follow-up studies at short term showed complete abolition of shunt in all 15 patients with no evidence of recanalization leading to recurrence of shunt. There was no death case or severe complication.Conclusion Interventional therapy is suggested to be a safe and effective method for coronary artery fistula. The short-term outcome of the intervention for coronary artery fistula is satisfied.