A Case of Coronary Cameral Fistula with associated Aneurysm: Role of ECG gated Multi Detector, Dual

2014-12-15 15:37:07

Category: Chest & Cardiac Imaging, Region: Thorax-Heart, Plane: MPR

A coronary cameral fistula (CCF) is an abnormal communication between a coronary artery and any cardiac chamber . CCF is an uncommon disorder with an incidence of 0.1% in patients undergoing coronary angiography . Although most patients are asymptomatic, it can lead to symptoms of angina pectoris. Commonly the right coronary artery is affected, although left sided coronary artery fistulae are well documented .Multiple fistulae may also occur. Over 90% of fistulae drain into the right side of the heart and therefore cause a shunt. Chronic large volume shunts through these fistulae may cause major aneurysmal enlargement of the proximal feeding coronary artery in addition to enlargement of the receiving vessel or chamber .The uninvolved coronary artery and chambers are usually normal . Most CCFs are reported as congenital and have only rarely been reported as acquired. Coronary cameral fistula with associated aneurysm (CCFAA) is even rarer .Multiple fistulae or multiple entry points may also occur, which affect the surgical management and can rarely be missed on catheter angiography. The termination sites of CCFs in decreasing order of frequency are the right ventricle, right atrium and left ventricle.MDCT may be advantageous over catheter angiography because of its ability to show the fistula separately from the surrounding cardiovascular and non vascular structures, along with any aneurysm or obstruction along its course. MDCT can provide accurate assessment of the size, location of a coronary artery aneurysm and the amount of thrombus present inside the aneurysm. It is also valuable in preoperative planning by showing spatial relations among the complex anatomy of the coronary artery fistula and aneurysm, great vessels, and heart.