관상동맥-폐동맥루의 관상동맥 CT 조영술 소견

Abstract

Purpose To evaluate the characteristics of coronary artery to pulmonary artery fistulae (CPAF) on coronary CT angiography (CTA).

Materials and Methods Among the 10,121 cases of coronary CTA for seven years, we experienced thirty-two cases of CPAF. We retrospectively evaluated their demographics, clinical symptoms, and anatomical characteristics such as the origin and its number, the course and opening site of fistula, and the presence of aneurysmal change (defined as dilatation 1.5 times the diameter of origins). We also categorized the fistula openings according to size, compared with those of the proximal left anterior descending artery (pLAD).

Results Patients were fourteen males and eighteen females with mean age of 56.5 years-old (range: 34-86). Nineteen patients had no relating symptoms. The remaining thirteen patients had symptoms such as angina, chest discomfort, palpitations and shoulder pain. Among them, two were diagnosed with coronary artery disease. Origins of CPAF were single (n=15, 46.9%) or multiple (n=17, 53.1%). They arose most commonly from the conus branch of the right coronary artery (n=20, 62.5%) and pLAD (n=17, 53.1%). All the CPAF coursed anterior to the main pulmonary artery, and drained into the anterolateral aspect. Twenty five cases (n=25, 78.1%) had aneurysmal changes. The openings were small in thirteen cases (n=13, 40.6%), medium in thirteen (n=13, 40.6%), and large in six (n=6, 18.8%).

Conclusion More than half of patients with CPAF had no relating symptoms. CPAF could have single or multiple origins. All of the CPAF coursed anterior to the main pulmonary artery, and drained into the anterolateral aspect with frequent aneurysmal change.