Case Report

Role of 256-slice MDCT in the evaluation of coronary artery fistula: A case series with review of literature

Case-1

A male neonate presented with features of cardiac failure at birth. On examination, besides tachycardia and tachypnoea, a loud continuous murmur was heard on auscultation. The patient was managed with injection digoxin (10 μg/kg/day). Echocardiography was done, which showed grossly dilated right coronary artery (RCA), which was found to be communicating with the right atrium (RA) and possibly with the right ventricle (RV) as well. Cardiac CT was done in 256-slice CT scanner, which showed grossly

Case-2

A six-month-old male infant patient presented with repeated attacks of respiratory tract infection since birth in the year 2012. Echocardiography showed dilated left coronary artery (LCA) and left anterior descending artery (LAD) with a dilated sac-like structure seen at the distal end of LAD suggestive of distal LAD aneurysm. A small communication was suspected between the aneurysmal sac and the right ventricle suggestive of CCF. For further evaluation, CCA was done. CCA showed dilated LCA and

Case-3

A 47-year old female patient presented with history of dyspnoea on exertion and recurrent episodes of chest pain for the past six months. Echocardiography demonstrated a 33 mm wide atrial septal defect (ASD) with left to right shunt and moderate tricuspid regurgitation (TR). Systemic to pulmonary blood flow ratio (Q_p/Q_s) was 3.2.

After putting the ASD closure device, routine CCA was done. Selective coronary angiography of LCA showed multiple small calibre tortuous arteries arising from LCA,

Case-4

A 65-year-old male patient, a known case of diabetes mellitus and hypertension, presented with recurrent episodes of chest pain and breathlessness on exertion for the past 01 month. CTCA showed a prominent conus branch of the RCA communicating with the MPA. A few prominent arterial channels were also seen arising from the proximal portion of LCA and LAD draining into the MPA (Fig. 6). Based on the CTCA findings, diagnosis of bilateral CAF arising from RCA as well as from LCA and LAD

Discussion

CAF is a rare congenital cardiac anomaly with an abnormal communication between the coronary artery and the cardiac chamber (CCF) or great systemic or pulmonary arteries or vena cava (coronary arterio-venous fistula) bypassing the myocardial capillary bed.¹ CAF is usually congenital, but acquired form has also been reported.

Lim et al. detected CAF in 56 patients (0.9%) in a retrospective study on 6341 patients who underwent CT coronary angiography. It was reported by the investigators that the

Conclusions

Ultrafast CT scan can be considered as the non-invasive imaging modality of choice for the diagnosis of CAF. It provides excellent 3D images and can accurately delineate fine anatomical details, which are required for management of CAF.

Conflicts of interest

The authors have none to declare.