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Noninvasive demonstration of dual coronary artery fistulas to main pulmonary artery with 64-slice multidetector-computed tomography: a case report.

Noda Y, Matsutera R, Yasuoka Y, Abe H, Adachi H, Hattori S, Araki R, Imanaka T, Kosugi M, Sasaki T - Cardiol Res Pract (2010)

Bottom Line: Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies.We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka 586-8521, Japan.

ABSTRACT
Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

No MeSH data available.


Related in: MedlinePlus

Axial images demonstrated the leakage of contrast medium (1) into the main pulmonary artery (MPA) from the aberrant artery originating from coronary arteries (2). Ao = ascending aorta.
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fig1: Axial images demonstrated the leakage of contrast medium (1) into the main pulmonary artery (MPA) from the aberrant artery originating from coronary arteries (2). Ao = ascending aorta.

Mentions: A 58-year-old woman with no history of cardiac disease was introduced to our hospital with atypical chest pain at rest and before sleeping at night for a month. Her risk factors for coronary artery disease were obesity and dyslipidemia, and she was administered with statin by a local clinic. On clinical examination, she had no murmur, and both chest X-ray and resting electrocardiogram were normal. We performed TTE and 64-slice MDCT (Aquilion 64, Toshiba Medical Systems, Japan) since treadmill exercise test indicated positive finding for myocardial ischemia. TTE revealed continuous flow into the main pulmonary artery which had peak flow in the diastolic phase. MDCT was performed with a retrospective ECG-gated protocol and with a collimation of 64 × 0.5 mm, detector pitch of 11.2, gantry rotation time of 350 ms, tube current of 400 mA, and tube voltage of 120 kV. She received 2 mg propranolol hydrochloride and sublingual nitroglycerin before scanning, and 59 mL of contrast medium (370 mg iodine/mL) was used for MDCT angiography. Axial images demonstrated the leakage of contrast medium into the main pulmonary artery from the aberrant artery originating from coronary arteries (Figure 1), and we could not detect any other leakages of contrast medium in the pulmonary artery. In addition, three-dimensional volume-rendered images revealed the network of aberrant arteries arising from both left anterior descending coronary artery and right coronary sinus (Figure 2). From these TTE and MDCT findings, we were able to diagnose her disease as coronary to pulmonary fistulas. Furthermore, these fistulas proved to be dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the same site of the main pulmonary artery. Subsequently, ICA confirmed these fistulas (Figure 3), but we could clearly demonstrate the course and the termination of the fistulas more with MDCT. She was not referred to surgical or percutaneous treatment, because the left-to-right shunt calculated by TTE and cardiac catheterization was not significant and the absence of pulmonary hypertension, heart failure, or myocardial ischemia was detected by radionuclide myocardial perfusion imaging.


Noninvasive demonstration of dual coronary artery fistulas to main pulmonary artery with 64-slice multidetector-computed tomography: a case report.

Noda Y, Matsutera R, Yasuoka Y, Abe H, Adachi H, Hattori S, Araki R, Imanaka T, Kosugi M, Sasaki T - Cardiol Res Pract (2010)

Axial images demonstrated the leakage of contrast medium (1) into the main pulmonary artery (MPA) from the aberrant artery originating from coronary arteries (2). Ao = ascending aorta.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2913845&req=5

fig1: Axial images demonstrated the leakage of contrast medium (1) into the main pulmonary artery (MPA) from the aberrant artery originating from coronary arteries (2). Ao = ascending aorta.
Mentions: A 58-year-old woman with no history of cardiac disease was introduced to our hospital with atypical chest pain at rest and before sleeping at night for a month. Her risk factors for coronary artery disease were obesity and dyslipidemia, and she was administered with statin by a local clinic. On clinical examination, she had no murmur, and both chest X-ray and resting electrocardiogram were normal. We performed TTE and 64-slice MDCT (Aquilion 64, Toshiba Medical Systems, Japan) since treadmill exercise test indicated positive finding for myocardial ischemia. TTE revealed continuous flow into the main pulmonary artery which had peak flow in the diastolic phase. MDCT was performed with a retrospective ECG-gated protocol and with a collimation of 64 × 0.5 mm, detector pitch of 11.2, gantry rotation time of 350 ms, tube current of 400 mA, and tube voltage of 120 kV. She received 2 mg propranolol hydrochloride and sublingual nitroglycerin before scanning, and 59 mL of contrast medium (370 mg iodine/mL) was used for MDCT angiography. Axial images demonstrated the leakage of contrast medium into the main pulmonary artery from the aberrant artery originating from coronary arteries (Figure 1), and we could not detect any other leakages of contrast medium in the pulmonary artery. In addition, three-dimensional volume-rendered images revealed the network of aberrant arteries arising from both left anterior descending coronary artery and right coronary sinus (Figure 2). From these TTE and MDCT findings, we were able to diagnose her disease as coronary to pulmonary fistulas. Furthermore, these fistulas proved to be dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the same site of the main pulmonary artery. Subsequently, ICA confirmed these fistulas (Figure 3), but we could clearly demonstrate the course and the termination of the fistulas more with MDCT. She was not referred to surgical or percutaneous treatment, because the left-to-right shunt calculated by TTE and cardiac catheterization was not significant and the absence of pulmonary hypertension, heart failure, or myocardial ischemia was detected by radionuclide myocardial perfusion imaging.

Bottom Line: Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies.We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka 586-8521, Japan.

ABSTRACT
Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

No MeSH data available.


Related in: MedlinePlus