coronary arteriovenous fistula ali sepahdari, md 4/6/07

Coronary Arteriovenous Fistula

Ali Sepahdari, MD

4/6/07

Fundamental CXR approach

Vessels ->----------------Heart size

INCREASED NORMAL OR DECREASED

ENLARGED VSD, ASD, PDA, PAPVC, other, TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s

Ebstein’s, Pulm sten, TA w/ restr. ASD, PA w/ intact IVS, transient TR

NORMAL OR SMALL

TAPR TOF; Pulm stenosis and VSD with: TGA, DOR/LV; hypoplastic RV, TR w/ ASD and pulm sten

Further subdivision…

VSD, ASD, PDA, PAPVC, other

TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s

Noncyanotic disease

Is there left atrial enlargement? If yes, then consider VSD and PDA, and

exclude ASD and PAPVC; then ask: Is there aortic arch enlargement?

If yes, then PDA is more likely than VSD Exception is in prematurity, where PDA is

more common and may not show arch enlargement

Coronary arteriovenous fistula Approximate incidence is 2 in 100,000 RCA and LCA probably about equal Drainage to RV more common than RA; can

drain to pulmonary artery All combinations have been seen Can be congenital or acquired -- sometimes

associated with other anomalies Sometimes asymptomatic -- presentation with

CHF and MI

Treatment Early ligation is preferred -- expect

persistent dilation of the ligated artery Sometimes do coronary bypass with

mammary artery graft Endovascular embolization also

extensively documented Unclear which method is more effective --

surgical ligation probably better

References Higgins CB. Clinical-radiographic Classification of Congenital Heart Disease. In

“Thoracic Imaging: Pulmonary and Cardiovascular Radiology”. LWW; 2006: 679-706

Wang NK et al. Coronary arteriovenous fistula in pediatric patients: a 17-year institutional experience. Journal of the Formosan Medical Association. 101(3):177-82, 2002 Mar.

Chopra V, et al. Isolated congenital coronary arteriovenous fistula. Indian Journal of Pediatrics. 67(9):661-4, 2000 Sep

Trejo Gutierrez, J F, et al. Coronary arteriovenous fistula. Study of 14 cases. Archivos del Instituto de Cardiologia de Mexico. 55(2):153-64, 1985 Mar-Apr

Mavroudis C, et al. Coronary Artery Fistulas in Infants and Children: A Surgical Review and Discussion of Coil Embolization. Ann Thorac Surg. 1997 May;63(5):1235-42.

Kamiya H, et al. Surgical treatment of congenital coronary artery fistulas: 27 years' experience and a review of the literature. Journal of Cardiac Surgery. 17(2):173-7, 2002 Mar-Apr